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Background/Objectives: Rock climbing is becoming more popular, leading to an increased focus on diagnosing and treating related injuries. Finger pulley and flexor tendon injuries are common among climbers, with the A2 pulley being the most frequently affected. High-resolution ultrasound (US) is the preferred method for detecting pulley injuries. This study aimed to determine the reliability and validity of US in identifying anatomical landmarks for diagnosing A2 pulley ruptures. Methods: This study was cross-sectional, involving 36 fingers from 4 cadaver arms. A Canon Aplio i800 US machine was used to measure two anatomical landmarks: the midpoint of the proximal phalanx and the distal edge of the A2 pulley. For the first anatomical landmark, the length of the proximal phalanx (PP distance), and for the second landmark, the distance between the distal edges of the proximal phalanx and the A2 pulley ("A" distance), were measured. Measurements were performed by two sonographers and compared to a digital caliper measurement taken post-cadaver dissection. Observers were blinded during measurements to ensure unbiased results. Results: Overall PP distance measured by US (O1: 37.5 ± 5.3 mm, O2: 37.8 ± 5.4 mm) tended to be shorter than caliper measurements (O3: 39.5 ± 5.5 mm). The differences between sonographers were minimal, but larger when compared to caliper measurements. High reliability for PP distance measurement was observed, especially between sonographers, with an ICC average of 0.99 (0.98, 1.00). However, reliability was lower for the "A" distance, with significant differences between US and caliper measurements. Regarding validity, US measurements were valid when compared to caliper measurements for PP distance, but not as reliable for the "A" due to wider confidence intervals. While US can substitute caliper measurements for PP distance (LR, Y:O2, X:O3, −0.70 (−3.28–1.38), 0.98 (0.93 ± 1.04)), its validity for "A" distance is lower (LR, Y:O2, X:O3, −2.37 (−13.53–4.83), 1.02 (0.62–1.75)). Conclusions: US is a reliable and valid tool in identifying anatomical landmarks for diagnosing A2 pulley ruptures, particularly for detecting the midpoint of the proximal phalanx. This is important to differentiate between complete and partial A2 pulley tears. However, the measurement of the "A" distance requires further refinement. These findings support efforts to standardize US examination protocols and promote consensus in diagnostic methodology, though further research is needed to address the remaining challenges. [ABSTRACT FROM AUTHOR]

Fetal age in Quarter Horses can be predicted within 2 weeks from 100- to 200- days of gestation using femur length, biparietal diameter (cranium diameter) and eye approximated volume. However, as pregnancy advances, the femur and cranium become too large to be imaged in their entirety using ultrasound and the corresponding biometric parameters can no longer be measured. In this longitudinal study, the proximal phalanx (P1) was evaluated as a novel biometric parameter for late gestation to predict fetal age and bone maturation. Transrectal ultrasound was performed in ten pregnant mares with known ovulation dates, every two weeks from 240- days of gestation until parturition. P1 was imaged in 69 % of the examinations. Inability to image P1 was due to obstructive positioning such as carpal or fetlock flexion, or posterior presentation of the fetus. Advancing fetal age did not affect visibility of P1. P1 length correlated significantly with days of gestation and a correlation equation was established: y = 0.3837x -69.55 where y is the predicted value of P1 length and x is the day of gestation (with day 0 being the day of ovulation). When P1 length was equal to or larger than the width of the ultrasound image (52.5 mm), 90 % of mares (9/10) were above 300- days of gestation. Ossification of the proximal and distal epiphysis of P1 typically appeared between 277- and 303 -days of gestation (mean: 288 days). The proximal epiphysis did not close before parturition whereas the distal one closed between 306- and 333-days of gestation (mean: 320 days). P1 epiphyseal appearance and closure occurred chronologically reflecting bone maturation. Radiographic findings at birth and prenatal ultrasound findings were in agreement, apart from timing of P1 distal epiphyseal closure. In conclusion, P1 length can be used as a new fetal biometric parameter to assess fetal age and growth after 240- days of gestation. The knowledge of P1 bone maturation process in utero as a marker for fetal bone development, may also be valuable in clinical decision-making when considering inducing parturition in the mare. [ABSTRACT FROM AUTHOR]

Invasive clonal species may exhibit different growth strategies than their native clonal competitors. In this study, we examined the spatial distribution of tiller outgrowth and the bud bank by comparing the investment in phalanx versus guerilla growth of a native and invasive perennial grass in North America. We also examined the effect of altered precipitation frequency, clipping, and competition on their clonal growth strategies. Investment in phalanx and guerilla growth was assessed by examining live propagule and tiller production from the plant crown versus its rhizomes. Although invasive Bromus inermis and native Pascopyrum smithii exhibited similar clonal growth strategies as young seedlings, their clonal growth strategies significantly differed by the end of their first growing season. Pascopyrum smithii invested in dual phalanx and guerilla tiller outgrowth and bud placement, and B. inermis primarily invested in phalanx tiller outgrowth and bud placement. Competition rather than intra-annual precipitation variability and clipping altered the clonal growth strategy of these species. Intra- and inter- specific competition did not alter tiller outgrowth for either species. However, inter-specific competition caused both species to alter their bud placement. Bromus inermis shifted more buds from phalanx to guerilla positions while P. smithii shifted in the opposite direction. This may enable invasive B. inermis to expand while confining native P. smithii to more localized areas in the future. Clonal growth strategies appear to be species specific and responsive to inter-specific competition. Investigating the belowground bud aspect of clonal growth can reveal the mechanism driving the future aboveground clonal growth strategy of native and invasive rhizomatous grasses and help inform the patterns of invasion within a plant community. [ABSTRACT FROM AUTHOR]

In this study we describe an adult left first pollical (thumb) proximal phalanx (I2-104) from the Baume de Moula-Guercy (Ardèche, France) and we evaluate its taxonomic status. We first describe this bone in detail, taking into account its pathology, before comparing it, through multivariate analyses, with a diverse sample of recent and fossil humans. Based on metric and morphological comparisons, we show that this phalanx belongs to a Neandertal individual who suffered from osteoarthritis. Osteoarthritis can have different origins, including overuse, degeneration, trauma and infection. Each of these possible etiologies is explored in our study. Although the cause is difficult to identify, the pathology in this individual may represent an inflammatory reaction caused by repeated and intense vibrations provoked by the high-frequency knapping of the left hand over time. [ABSTRACT FROM AUTHOR]

To date, only a few studies have dealt with the radiological changes of the coffin bone in all equids in terms of roughness of the bone edges, bone resorption as well as remodeling processes and bone deformation. It seems to be an empiric finding that remodeling processes, the associated deformation and new bone formation on the coffin bone are a normal sign of ageing in donkeys. So far, there are no profound studies or publications on corresponding changes in donkeys and their dependence on the age of the animal. The objective of this study is to describe the normal radiographic anatomy of the donkey's coffin bone and to investigate the occurrence of pathological abnormalities, particularly in relation to the age of the animal. Furthermore, the study aims to prove that the changes mentioned above are not a normal sign of ageing in donkeys, but rather pathological conditions, for example as a result of chronic laminitis. Lateromedial radiographs of the distal toe of all limbs of 42 clinically healthy and lameness-free donkeys of European breeds were taken. The occurrence and severity of radiographic changes in the coffin bone were assessed using a scoring system. The tip as well as the extensory processus of the coffin bone were each assessed with regard to the presence of a sharply defined contour. The parietal and sole surfaces were also assessed for the presence of a smooth contour, slight irregularities through to moderate and severe changes and exostoses. The statistical evaluation was carried out with particular attention to the dependence of the changes on the age of the animal. A total of 160 limbs were examined. 28.1% of the coffin bones showed a sharply contoured coffin bone tip, whereas 71.9% showed deviations from the described norm in the sense of a blurred or rounded contour of the coffin bone tip, atrophic and lytic processes in the area of the coffin bone tip or the formation of a cap. The majority of these changes (69.5%) were minor deviations in the sense of a blurred or rounded contour of the coffin bone tip. In the present study, severe changes to the tip of the coffin bone, i.e. atrophy and cap formation, occurred more frequently on the forelimbs than on the hind limbs. The age as well as the weight of the donkeys had a significant influence on the occurrence of changes of the coffin bone tip (p<0.05). While age showed a negative correlation with the changes in the tip of the coffin bone, a positive correlation was found in relation to weight. 10.7% of the coffin bones showed a blurred contour in the area of the extensory processus. With regard to changes in extensory processus no significant correlation with age (p=0.3864) or limb (p=0.0962), but a positive correlation with the weight of the donkeys was found (p<0.05). The parietal surface was smooth in the majority of the cases (65%), 28.1% showed slight roughness of the parietal surface and only 6.9% showed moderate to severe changes, mainly on the front limbs. Age had no significant influence on changes in parietal surface (p=0.2958). However, weight was positively correlated with changes in parietal area and the forelimbs showed significantly more changes than the hindlimbs (p<0.05). In contrast to the parietal surface, the sole surface was sharply contoured in only 28.7% of all cases. The majority (62.5%) showed mild irregularities of the sole surface, moderate changes occurred in 8.8% of the cases and mainly on front limbs. The only parameter that influenced the occurrence of changes in the sole surface significantly was the weight of the specimens, whereas the age (p=0.1712) and the limb (p=0.1432) showed no significant correlation. Overall, almost all (41 of 42 subjects) donkeys showed changes in the coffin bone on at least one limb. The anatomical appearance of the coffin bone of the donkey is similar to that of the horse. Ideally, the tip of the coffin bone should be angular and sharply contoured, whereby a slightly rounded or somewhat unclear contour should not be regarded as pathological. The extensor process should be sharply contoured. The parietal surface should be as smooth as possible, whereas a slightly irregular contour of the sole surface can still be considered normal. In summary, it can be said that radiologically detectable changes in the coffin bone are common even in a clinically healthy donkey population and that, contrary to empirical claims, their occurrence and severity correlate less with the age of the animals and more with their weight. [ABSTRACT FROM AUTHOR]

Chondroblastoma, a rare benign bone tumor, is typically found in the epiphysis of long bones, with hand involvement being particularly uncommon. We present a case of an 11-year-old female with chondroblastoma involving the fourth distal phalanx of the hand. Imaging revealed a lytic, expansile lesion with sclerotic margins and no soft tissue component. A preoperative differential diagnosis included intraosseous glomus tumor, epidermal inclusion cyst, enchondroma, and chronic infection. The patient underwent open surgical biopsy and curettage for both diagnostic and treatment purpose. The final histopathologic diagnosis was chondroblastoma.

The article presents a case study of an 18-year-old female U.S. Military Academy cadet who sustained a right third distal interphalangeal joint dislocation during a rugby match. Topics discussed include the initial examination and imaging results, the decision for open reduction and internal fixation (ORIF) surgery, and the patient's return to rugby after a 5-month recovery period.

The purpose of this systematic review and meta-analysis was to compare the clinical and radiographic outcomes between patients undergoing scarf osteotomy and scarf-Akin osteotomy for the management of hallux valgus deformity. A systematic review of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following scarf osteotomy and scarf-Akin osteotomy for the treatment of hallux valgus were included and assessed. The level and quality of evidence of the included studies were also evaluated. Four studies were included. In total, 388 patients (408 toes) underwent scarf osteotomy alone and 287 patients (295 toes) underwent scarf-Akin osteotomy for the treatment of hallux valgus deformity. There was no difference in postoperative American orthopedic foot and ankle society scores (p = 0.7828), visual analog scale scores (p = 0.4558), hallux valgus angle (p = 0.5116), intermetatarsal angle (p = 0.4830), proximal to distal phalangeal articular angle (p = 0.2411) between the scarf alone cohort and the scarf-Akin cohort. Similarly, there was no difference in complication rates (p = 0.6881) nor secondary surgical procedure rates (p = 0.3678) between the 2 cohorts. Finally, there was a higher recurrence rate in the scarf-alone cohort (11.4%) compared to the scarf-Akin cohort (5.7%), but this was not statistically significant (p = 0.4414). This systematic review demonstrates lower recurrence rates following scarf-Akin osteotomy compared to scarf osteotomy alone for the treatment of hallux valgus deformity. No difference in complication rates were noted between the 2 cohorts. Our review demonstrates that both the scarf osteotomy and the scarf-Akin osteotomy may be effective and safe procedures, however, the scarf-Akin osteotomy may provide more long-term benefit in the setting of moderate to severe hallux valgus. [ABSTRACT FROM AUTHOR]

Introduction Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care. Materials and Methods The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military. Results The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers. Conclusions Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to "red flags," primary care providers can manage most of these injuries with short-term follow-up with orthopedics. [ABSTRACT FROM AUTHOR]

Case: Glomus tumors of the hand are rare tumors that occur predominantly in the subungual region. Though multicentric glomus tumors have been reported in the subungual region involving the nailbed, monostotic multiple intraosseous glomus tumors have not been reported so far. We report a case of a 36 year-old woman who presented with a 5-year history of intermittent thumb pain, aggravated with exposure to cold or pressure. A glomus tumor of the thumb was excised, but symptoms returned 3 months later. She ultimately underwent curettage with bone grafting of a recurrent glomus tumor at the same site, and has been free of symptoms for 1.5 years. Conclusion: Intraosseous glomus tumors may present as multiple synchronous lesions. This, to the best of our knowledge, is the first case report of monostotic multiple intraosseous glomus tumors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rock climbing is becoming more popular, leading to an increased focus on diagnosing and treating related injuries. Finger pulley and flexor tendon injuries are common among climbers, with the A2 pulley being the most frequently affected. High-resolution ultrasound (US) is the preferred method for detecting pulley injuries. This study aimed to determine the reliability and validity of US in identifying anatomical landmarks for diagnosing A2 pulley ruptures. Methods: This study was cross-sectional, involving 36 fingers from 4 cadaver arms. A Canon Aplio i800 US machine was used to measure two anatomical landmarks: the midpoint of the proximal phalanx and the distal edge of the A2 pulley. For the first anatomical landmark, the length of the proximal phalanx (PP distance), and for the second landmark, the distance between the distal edges of the proximal phalanx and the A2 pulley (“A” distance), were measured. Measurements were performed by two sonographers and compared to a digital caliper measurement taken post-cadaver dissection. Observers were blinded during measurements to ensure unbiased results. Results: Overall PP distance measured by US (O1: 37.5 ± 5.3 mm, O2: 37.8 ± 5.4 mm) tended to be shorter than caliper measurements (O3: 39.5 ± 5.5 mm). The differences between sonographers were minimal, but larger when compared to caliper measurements. High reliability for PP distance measurement was observed, especially between sonographers, with an ICC average of 0.99 (0.98, 1.00). However, reliability was lower for the “A” distance, with significant differences between US and caliper measurements. Regarding validity, US measurements were valid when compared to caliper measurements for PP distance, but not as reliable for the “A” due to wider confidence intervals. While US can substitute caliper measurements for PP distance (LR, Y:O2, X:O3, −0.70 (−3.28–1.38), 0.98 (0.93 ± 1.04)), its validity for “A” distance is lower (LR, Y:O2, X:O3, −2.37 (−13.53–4.83), 1.02 (0.62–1.75)). Conclusions: US is a reliable and valid tool in identifying anatomical landmarks for diagnosing A2 pulley ruptures, particularly for detecting the midpoint of the proximal phalanx. This is important to differentiate between complete and partial A2 pulley tears. However, the measurement of the “A” distance requires further refinement. These findings support efforts to standardize US examination protocols and promote consensus in diagnostic methodology, though further research is needed to address the remaining challenges.

Chondroblastoma, a rare benign bone tumor, is typically found in the epiphysis of long bones, with hand involvement being particularly uncommon. We present a case of an 11-year-old female with chondroblastoma involving the fourth distal phalanx of the hand. Imaging revealed a lytic, expansile lesion with sclerotic margins and no soft tissue component. A preoperative differential diagnosis included intraosseous glomus tumor, epidermal inclusion cyst, enchondroma, and chronic infection. The patient underwent open surgical biopsy and curettage for both diagnostic and treatment purpose. The final histopathologic diagnosis was chondroblastoma.

Advanced cross-sectional imaging techniques are firmly established as a means of evaluating musculoskeletal disease, and ultrasound (US) is increasingly being used for the assessment of a diversity of tendon, joint, and soft-tissue abnormalities. A benign condition – bizarre parosteal osteochondromatous proliferation (BPOP) – arises from the periosteum, typically in the small bones of the hands and feet, and grows as a surface bone lesion in the surrounding soft tissue. Proliferations can become symptomatic, exercising mass effect on adjacent structures that may require operative management. As a bone-forming process, BPOP may occasionally assume worrisome histologic features that mimic sarcoma, and a pronounced tendency to recur after primary excision. A solitary mass was growing in the middle finger of a young woman that curtailed proper hand function. With US, a partially ossified formation was revealed in the proximal phalanx situated on the outer surface of the bone. There was faint acoustic shadowing distal to the lesion, and a hypoechoic halo was seen covering part of the abnormal tissue growth. Importantly, the lesion caused significant limitation of motion of the finger, on the dynamic flexion US images with the displacement of the flexor tendon and compression of a digital nerve. To restore the range of motion in the finger, surgical excision of the juxtacortical mass was performed and histology yielded a diagnosis of BPOP. We describe the US features of digital BPOP, which were found to correspond closely to those of computed tomography and magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Acrometastasis, especially in the hands and fingers, is a rare clinical condition resulting from primary cancers such as lung, breast, kidney, and, rarely, thyroid cancer. Acrometastasis tends to be the tip of the iceberg in patients with extensive systemic disease, which could be regional, pulmonary, skeletal, neurological, or all of them combined. Even though these tumors are clearly visible and symptomatic, the diagnosis is usually misleading because such distal metastatic disease is not thought of at first. In general, systemic treatments should be given to any patient presenting digital acrometastasis. We describe two cases of papillary thyroid carcinoma and digital acrometastasis as a sign of advanced disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Intraosseous epidermoid cysts in this report were related to a previous injury. A careful history taking is necessary to make a correct impression on the lesion. Definite diagnosis is made by histologic study. This report presents two cases of intraosseous epidermoid cyst of the finger treated with curettage and autogenous bone graft. Radiographs showed a radiolucent lesion with a sclerotic margin. Histologic examination revealed a cystic wall consisting of stratified squamous epithelial cells and keratinized material in the cyst, consistent with an epidermoid cyst. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to predict sex with machine learning (ML) algorithms by making morphometric measurements on radiological images of the first and fifth metatarsal and phalanx bones. Materials and methods: In this study, radiologic images of 263 individuals (135 female, 128 male) between the ages of 27 and 60 were analysed retrospectively. The images in digital imaging and communications in medicine (DICOM) format were transferred to personal workstation Radiant DICOM Viewer programme. Length and width measurements of the first and fifth metatarsal and foot phalanx bones were performed on the transferred images. In addition, the ratios of the total length of the first proximal and distal phalanx and length of the first metatarsal and total length of fifth proximal, middle, and distal phalanx and maximum length of fifth metatarsal were calculated. Results: As a result of machine learning algorithms, highest accuracy, specificity, sensitivity, and Matthews correlation coefficient values were found as 0.85, 0.86, 0.85, and 0.71, respectively with decision tree algorithm. It was found that accuracy rates of other algorithms varied between 0.74 and 0.83. Conclusions: As a result of our study, it was found that sex estimation was made with high accuracy rate by using machine learning algorithms on X-ray images of the first and fifth metatarsal and foot phalanx. We think that in cases when pelvis, cranium and long bones are harmed and examination is difficult, bones of the first and fifth metatarsal and foot phalanx can be used for sex estimation. [ABSTRACT FROM AUTHOR]

Advanced cross-sectional imaging techniques are firmly established as a means of evaluating musculoskeletal disease, and ultrasound (US) is increasingly being used for the assessment of a diversity of tendon, joint, and soft-tissue abnormalities. A benign condition – bizarre parosteal osteochondromatous proliferation (BPOP) – arises from the periosteum, typically in the small bones of the hands and feet, and grows as a surface bone lesion in the surrounding soft tissue. Proliferations can become symptomatic, exercising mass effect on adjacent structures that may require operative management. As a bone-forming process, BPOP may occasionally assume worrisome histologic features that mimic sarcoma, and a pronounced tendency to recur after primary excision. A solitary mass was growing in the middle finger of a young woman that curtailed proper hand function. With US, a partially ossified formation was revealed in the proximal phalanx situated on the outer surface of the bone. There was faint acoustic shadowing distal to the lesion, and a hypoechoic halo was seen covering part of the abnormal tissue growth. Importantly, the lesion caused significant limitation of motion of the finger, on the dynamic flexion US images with the displacement of the flexor tendon and compression of a digital nerve. To restore the range of motion in the finger, surgical excision of the juxtacortical mass was performed and histology yielded a diagnosis of BPOP. We describe the US features of digital BPOP, which were found to correspond closely to those of computed tomography and magnetic resonance imaging.

Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS – a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility) [ABSTRACT FROM AUTHOR]

Key Clinical Message Intraosseous epidermoid cysts in this report were related to a previous injury. A careful history taking is necessary to make a correct impression on the lesion. Definite diagnosis is made by histologic study. Abstract This report presents two cases of intraosseous epidermoid cyst of the finger treated with curettage and autogenous bone graft. Radiographs showed a radiolucent lesion with a sclerotic margin. Histologic examination revealed a cystic wall consisting of stratified squamous epithelial cells and keratinized material in the cyst, consistent with an epidermoid cyst.

It has been recognized as early as the Victorian era that the apex of the distal phalanx has a distinct embryological development from the main shaft of the distal phalanx. Recent studies in regenerative medicine have placed an emphasis on the role of the apex of the distal phalanx in bone regrowth. Despite knowledge about the unique aspects of the distal phalanx, all phalanges are often treated as equivalent. Our morphological study reiterates and highlights the special anatomical and embryological properties of the apex of the distal phalanx, and names the apex "the bony cap" to distinguish it. We posit that the distal phalanx shaft is endochondral, while the bony cap is intramembranous and derived from the ectodermal wall. During development, the bony cap may be a separate structure that will fuse to the endochondral distal phalanx in the adult, as it ossifies well before the distal phalanges across taxa. Our study describes and revives the identity of the bony cap, and we identify it in three mammalian species: humans, cats, and horses (Homo sapiens, Felis catus domestica, and Equus caballus). During the embryonic period, we show the bony cap has a thimble-like shape that surrounds the proximal endochondral distal phalanx. The bony cap may thus play an inductive role in the differentiation of the corresponding nail, claw, or hoof (keratin structures) of the digit. When it is not present or develops erroneously, the corresponding keratin structures are affected, and regeneration is inhibited. By terming the bony cap, we hope to inspire more attention to its distinct identity and role in regeneration. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Our aim in this study is to evaluate patients with phalangeal benign soft-tissue tumors of the hand and to evaluate their short-term complications after surgery. METHODS: Between January 2019 and October 2021, 59 patients (31 female, 28 male; mean age 48.96+-13.33, range 20–75 years) with phalangeal soft-tissue tumors were evaluated according to demographic data, histopathological diagnosis, satisfaction level, recurrence, and complications. RESULTS: The most common phalangeal soft-tissue tumor was tenosynovial giant cell tumors (n=15, 38.4%). Other frequent histologies included ganglion cysts (12.8%), epidermal inclusion cyst (10.25%), and fibrolipoma (7.6%). Soft-tissue tumors were most commonly found on second and third phalanx (both 26.2%), followed by fourth (13.8%), first (12.3%), and fifth (9.2%) The location of soft-tissue tumors was found in the phalanx of hands that were 40% proximal, 29.2% distal, and 30.8% in different parts of the phalanx. The mean visual analog scale score was 5.9+-3.1 before excisional surgery; it was 3.47+-1.3 at the last follow-up (p

BackgroundThe bony mallet finger is a tear fracture of the extensor tendon, resulting in a flexion deformity of the finger, which affects both the function of the finger. The classical Ishiguro's method is associated with damage to the cartilage of the distal interphalangeal (DIP) joint and always lead to the joint stiffness. This paper explores a new technique to overcome the shortcomings of the classical Ishiguro's method and achieve better clinical efficacy.MethodsWe examined 15 patients with bony mallet fingers, 9 males and 6 females, from February 2020 to June 2022, ranged from 23 to 58 years, including 1 case of index finger, 5 cases of middle finger, 3 cases of ring finger and 6 cases of little finger. The median course of the injury to surgery was 2 days (range, 1∼7 days). All had fresh closed injuries, according to the Wehbe and Schneider classification: 4 cases of type IA, 6 cases of type IB, 3 cases of type IIA and 2 cases of type IIB. All patients were treated surgically by the new technique. Post-operative follow-up was conducted to record the healing of the fracture, the pain of the affected finger and the function of joint movement.ResultsThe 15 cases were followed up after surgery. The median active range of motion was 65° (range, 55∼75°). The median extension deficit of DIP joint was 0° (range, 0∼11°). The median clinical healing time of the fracture was 6 weeks (range, 6∼10 weeks). None of the patients experienced significant pain. The patients were assessed according to the Crawford criteria at the final follow-up: 11 cases were assessed as excellent, 3 cases were assessed as good and 1 case was assessed as fair. No loss of fracture repositioning, loosening of internal fixation, skin necrosis or infection was observed.ConclusionThe application of the new technique for the treatment of bony mallet fingers has the advantages of good stability, fracture healing and functional recovery of the DIP joint, making it an ideal surgical procedure for the treatment of fresh bony mallet fingers.

It has been recognized as early as the Victorian era that the apex of the distal phalanx has a distinct embryological development from the main shaft of the distal phalanx. Recent studies in regenerative medicine have placed an emphasis on the role of the apex of the distal phalanx in bone regrowth. Despite knowledge about the unique aspects of the distal phalanx, all phalanges are often treated as equivalent. Our morphological study reiterates and highlights the special anatomical and embryological properties of the apex of the distal phalanx, and names the apex “the bony cap” to distinguish it. We posit that the distal phalanx shaft is endochondral, while the bony cap is intramembranous and derived from the ectodermal wall. During development, the bony cap may be a separate structure that will fuse to the endochondral distal phalanx in the adult, as it ossifies well before the distal phalanges across taxa. Our study describes and revives the identity of the bony cap, and we identify it in three mammalian species: humans, cats, and horses (Homo sapiens, Felis catus domestica, and Equus caballus). During the embryonic period, we show the bony cap has a thimble-like shape that surrounds the proximal endochondral distal phalanx. The bony cap may thus play an inductive role in the differentiation of the corresponding nail, claw, or hoof (keratin structures) of the digit. When it is not present or develops erroneously, the corresponding keratin structures are affected, and regeneration is inhibited. By terming the bony cap, we hope to inspire more attention to its distinct identity and role in regeneration.

Metastases that affect the distal regions of the upper and the lower extremities are called acrometastases and they affect the bones and the overlying tissues. Various cancer types may have single or multiple acrometastases. A sixty-four-year-old female patient had a painful and enlarging mass at the tip of the fifth digit of her right hand. The lesion appeared as a red macule at the junction between the nail plate and the hyponychium. The patient was in her seventh postoperative year after a left-sided radical nephrectomy with a histopathological diagnosis of renal clear cell carcinoma. Due to multiple metastases to the spleen and left femoral head, she had been treated with twenty sessions of radiotherapy and she was under nivolumab therapy twice a month for two years. A punch biopsy revealed a gland forming, CD 10, PAX 8 and vimentin-positive renal clear cell carcinoma metastasis. The patient was treated with amputation of the distal phalanx. Although rare, acrometastasis should be included in the differential diagnosis of patients with a history of renal clear cell carcinoma. [ABSTRACT FROM AUTHOR]

The hand is an extremely rare site for giant cell tumor (GCT). There are only a few reported cases of GCT including the hand, and even fewer reporting involvement of phalanges. GCTs in small bones are typically more aggressive and have higher local recurrence and rate of metastasis in younger patients compared to long bone involvement, so the treatment is more clinically challenging in the hand. In this study, we present the management of giant cell tumors of the proximal phalanxin two patients treated with two different method; ray resection and arthrodesis using an iliac crest graft. [ABSTRACT FROM AUTHOR]

Background: Fractures of the hand, specifically the metacarpals and phalanges, are a common injury. Whilst many of these fractures can be treated non‐operatively, a number of advances have led to the increase in popularity of surgical intervention. The aim of this study was to assess and describe trends in management of phalangeal and metacarpal fractures in Australia over the last two decades. Methods: A review was conducted of the Medicare Benefits Scheme (MBS), specifically querying the item numbers pertaining to the management of metacarpal and phalanx fractures. Data was recorded as the incidence per 100 000 patients. Results: Overall, there was a statistically significant decrease in the incidence of closed reduction of metacarpal and phalanx fractures, with a converse statistically significant increase in open reduction internal fixation. Conclusion: This study demonstrates that over the last 20 years, there has been a decrease in closed reduction of intra‐ and extra‐articular phalangeal and metacarpal fractures, with a converse but smaller increase in open reduction and fixation. These trends are likely multi‐factorial in aetiology, and should be monitored to guide resource allocation and health provision in the future. [ABSTRACT FROM AUTHOR]

Paediatric hand fracture care presents unique considerations and challenges. The proximal phalanx is the most injured location. This review details pearls for the examination of the injured paediatric hand, immobilisation considerations and treatment strategies. Over-treatment can lead to unnecessary stiffness, missed activities, increased healthcare costs or unnecessary surgical morbidity. Undertreatment can promote malunion and dysfunction. Fracture patterns discussed include those of the phalangeal head, neck, shaft and base. The concepts covered will help optimise the evaluation and treatment of children with injured proximal phalanges. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Most unstable hand fractures in children are treated by closed methods. If osteosynthesis is required, Kirschner (K)-wires are commonly used, though they carry a risk of injury to the physis. We have been using a mini external fixator system (MEFS) for the treatment of unstable periphyseal fractures of the hand. The aim of this study is to describe the application and report the outcomes of MEFS for the treatment of periphyseal fractures of the hand. Methods: We retrospectively reviewed all the patients with periphyseal fracture of the hand treated with MEFS from March 2010 to December 2019. Data with regard to age, sex, hand dominance, digit and bone injured, mechanism of injury, medical records and related radiographs were collected. Salter–Harris classification was used to classify epiphyseal fractures and the Al-Qattan classification for categorising neck fractures. Range of motion and residual deformity of the affected fingers were evaluated during follow-up and at 3 months postoperatively. Results: Fourteen periphyseal unstable fractures were treated using closed reduction and MEFS. Only one patient with a fracture of the neck of the proximal phalanx of the little finger required revision surgery. No patient had pin site infection or pin loosening and the device was well tolerated by all patients. All fractures united and all the patients recovered a full range of motion at final follow-up. Conclusions: The MEFS is a reasonable alternative for unstable periphyseal fractures with good outcomes and avoids the risk of iatrogenic physeal injury from K-wire fixation. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Background and objective. Enchondromas are the most common primary tumors involving phalanges of the hand. When they are identified in asymptomatic patients, surgeons must decide between surgery or watchful waiting. Till the date, there is no established radiological parameter for determining the risk of pathological fracture. Our study aims to determine the utility of two radiographic indicators, amount of cortical thinning and bone area occupied by tumor, as predictors of pathological fracture. Methods. Retrospective, observational and analytic, case-control study, conducted between 2003 and 2017. Eighteen patients with enchondromas of phalanges of the hand were operated on; 9 of them were asymptomatic (control, group A), and in the other 9 cases (group B), pathological fracture was the first presenting symptom of disease. In order to identify radiological parameters associated with pathological fracture, we analyzed their anteroposterior and lateral preoperative radiographs. We measured the bone area occupied by tumor, and the amount of cortical thinning, in both groups. Results. There was no statistically significant difference between the two groups with respect to bone area occupied by tumor (p > 0.1). Nevertheless, the amount of cortical thinning was significantly higher in group B (p < 0.1). The probability of developing a pathological fracture was increased in bones with greater cortical thinning. This was observed in anteroposterior radiographs [Odds Ratio (OR) 16, Confidence Interval (CI) 90% 1.97-130.24] (p=0.01) and in lateral radiographs (OR 7, CI 90% 1.21-40.62) (p=0.03). Conclusions. Our study suggests a positive association between cortical thinning and development of pathological fracture in hand phalanges affected by enchondromas. [ABSTRACT FROM AUTHOR]

The article examines the influence of Xenophon’s didactic works on the military activi-ties of Alexander the Great. It is revealed that messages from ancient sources containing direct indications of the fact that Alexander was familiar with Xenophon’s works are either fundamen-tally unreliable or subject to different interpretations. Nevertheless, a comparison of the rec-ommendations proposed in "Kyropedia" and other Athenian author’s writings the with Alexan-der’s practical activities reveals obvious similarities in their views on training military person-nel, organizing competitions in military skill, providing soldiers with richly decorated weapons, and caring for the sick and wounded. A set of coincidences is associated with the political and administrative activities of Alexander, who, like Cyrus the Elder in Xenophon’s writings, demonstratively showed mercy towards the vanquished, attracted representatives of the local elite to the service, wore clothes traditional for a conquered country. A large number of similar-ities, good education of Alexander and the popularity of Xenophon’s writings in the second half of the 4th century BCE allow us to conclude that the Macedonian king was familiar with the works of the Athenian author. However, the components of Xenophon's didactic legacy associ-ated with the methods of warfare do not correlate well with Alexander's military leadership practice. The fundamental differences are revealed in the armament of the cavalry and their tac-tics, the depth of the infantry formation, the role of army branches on the battlefield. They were caused by a significant breakthrough in the art of war that took place in Macedonia during the time of Philip II. This breakthrough also led to the emergence of new tactics that provided for crushing the enemy not with a frontal attack of heavy infantry, but through the combined use of various types of troops. Alexander as a military leader was raised under the conditions of a new, more developed military art. Thus, the overwhelming majority of Xenophon's recommenda-tions, which described the cavalry as a purely auxiliary branch of the army and considered the classical hoplite phalanx a decisive force in battle, were clearly irrelevant for him and therefore ignored.

Lytic lesions arising in the hand can be confused with an enchondroma. Enchondroma is the most common tumor of the hand and can present with varied features. It often requires only observation. A dilemma arises when surgically treatable lesions like aneurysmal bone cyst (ABC) present in uncommon locations like the hand. To diagnose a lytic lesion in the hand, percutaneous biopsy is commonly done. But, percutaneous biopsy is unnecessary in enchondroma and may not be useful in conditions like simple bone cyst and ABC. In such situations, magnetic resonance imaging (MRI) can differentiate between the most frequent benign lesions of the hand thereby reducing the need for invasive procedures. We present a 25-year-old lady who presented with a painless right index finger swelling for the past 6 months. Radiographs revealed a lytic expansile lesion in the proximal phalanx of the hand. MRI showed multiple fluid-fluid levels. Curettage and autologous iliac crest bone grafting was done. Histopathology confirmed the diagnosis of an ABC. The patient was followed up for 12 months without any recurrence. We briefly review the paucity of literature on the diagnostic approach to benign lytic lesions of the hand.

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Purpose: Report the epidemiological and lesion aspects of hand bone fractures in children. Patients and method: We did a retrospective and descriptive study over a 10-year period. This study involved 222 children under the age of 16 with 261 fracture cases. The parameters studied were frequency, age, sex, mechanism, circumstances of fracture, consultation time, data from standard physical examination and x-ray of the hand, and associated lesions. Results: Hand bone fractures accounted for 6.4% of all fractures in children in our service. The average age of the children was 8.5 years with a standard deviation of 4. There was a male predominance with a sex ratio of 2. Domestic accidents led the way with 44.3% of cases. They were followed by playful accidents with 33.94% of cases. Receiving heavy objects and falling with hand reception were the most common mechanisms. 62.8% of patients consulted within the first 24 hours. All fractures were in the metacarpals and phalanxes with 31% and 69% of cases, respectively. Head and diaphysis fractures each accounted for 28.1% of cases followed by cervical fractures with 27.8%. Non-displaced fractures accounted for 65% of cases. Associated lesions were found in 10 patients. Conclusion: Hand bone fractures are quite common. They often interest the big child in the decoy of a domestic or playful accident, by crushing the hand or falling with reception on the hand. Fractures of the phalanxes are the most common while those of carp are absent. [ABSTRACT FROM AUTHOR]

Current approaches to quantify phalangeal curvature assume that the long axis of the bone's diaphysis approximates the shape of a portion of a circle (included angle method) or a parabola (second‐degree polynomial method). Here we developed, tested, and employed an alternative geometric morphometrics‐based (GM) approach to quantify diaphysis shape of proximal phalanges in humans, apes and monkeys with diverse locomotor behaviors. One hundred landmarks of the central longitudinal axis were extracted from 3D surface models and analyzed using 2DGM methods, including generalized Procrustes analyses. Principal components analyses were performed and PC1 scores (>80% of variation) represented the dorsopalmar shape of the bone's central longitudinal axis and separated taxa consistently and in accord with known locomotor behavioral profiles. The most suspensory taxa, including orangutans, hylobatids and spider monkeys, had significantly lower PC1 scores reflecting the greatest amounts of phalangeal curvature. In contrast, bipedal humans and the quadrupedal cercopithecoid monkeys sampled (baboons, proboscis monkeys) exhibited significantly higher PC1 scores reflecting flatter phalanges. African ape (gorillas, chimpanzees and bonobos) phalanges fell between these two extremes and were not significantly different from each other. PC1 scores were significantly correlated with both included angle and the a coefficient of a second‐degree polynomial calculated from the same landmark dataset, but had a significantly higher correlation with included angles. Our alternative approach for quantifying diaphysis shape of proximal phalanges to investigate dorsopalmar curvature is replicable and does not assume a priori either a circle or parabola model of shape, making it an attractive alternative compared with existing methodologies. [ABSTRACT FROM AUTHOR]

Examination of the hand in a logical fashion using the 'look, feel, move' method and a good basic knowledge of the relevant anatomy are important to be able to formulate differential diagnoses and identify common pathologies. This article aims to take the reader through the relevant clinical anatomy and then provide a step-by-step guide to examination of the hand and wrist. It is concluded with an overview of the typical findings in common conditions including arthritis, Dupuytren's disease and nerve injuries. [ABSTRACT FROM AUTHOR]

INTRODUCTION[|]We retrospectively examined extra-articular proximal phalangeal fractures excluding the thumb, for which fixation was applied using locked miniplates, with the aim to compare the results of the dorsal and midlateral approaches.[¤]METHODS[|]26 patients were operated via the dorsal approach (Group 1) and 20 patients were operated via the midlateral approach (Group 2). No graft was used in any patient. No splint was applied to any patient after the operation. Active finger movements were resumed on postoperative day 1. [¤]RESULTS[|]The mean ages of patients in Groups 1 and 2 were 35.1 (range: 18–60) years and 33.8 (17–71) years, respectively. Union was achieved in all patients in the study. In Group 1, the mean total active movement (TAM) was 228° (range: 170–270°); according to the digital functional assessment, 18 patients had excellent, 7 patients had good, and 1 patient had fair results. In Group 2, mean TAM was 239° (range: 200–270°); according to the digital functional assessment, 14 patients had excellent and 6 patients had good results. [¤]DISCUSSION AND CONCLUSION[|]We believe that both dorsal and midlateral approaches in extra-articular proximal phalangeal fractures are effective and reliable methods with similar clinical and functional results, and are thus a suitable alternative for each other.[¤]

The article discusses the organization, content and effectiveness of the training process for the soldiers of the Macedonian phalanx during the time of Philip II and Alexander III. The basis for the study is a comparison of direct instructions of the ancient written tradition dating back to Ephorus with other data on the socio-political and military development of Macedonia in the 4th century BC. It is revealed that the Macedonian heavy footmen were mainly recruited from people from the countryside who were physically fit. The possibility to select candidates for the army was provided by the country's high demographic potential. The Macedonians were motivated to join the royal army by the possibility to increase their social status and improve their financial situation through a salary and land allotment. The features of the Macedonian phalanx as a type of forming-up determined the content of training for new recruits. It included combat training, during which the skill to embattle in various types of battle order and to move seamlessly according to orders was formed. An important component of the training was practicing the techniques for handling a long sarissa spear. To ensure the mobility of the army and endurance in fighters, training marches with full military equipment and a supply of provisions were practiced. A whole range of measures was aimed at the formation of strict military discipline, not characteristic of the Macedonian infantry in the previous periods. All this made it possible to quickly create and consistently increase the phalanx of sarissophores. The existing shortcomings in individual training were compensated by the accumulated combat experience, which was facilitated by the professional character of the Macedonian army. Organizationally, the phalangite corps was divided into taxes, which had a permanent personnel and consisted of the people, born in the same region, both veterans and youth. In the battle order of the phalanx, the most dangerous and responsible positions were occupied by experienced warriors. This ensured the combat effectiveness of each taxis and survival of inexperienced phalangites, who had the opportunity to adopt skills from veterans.

Tuberculous infection of the extrapulmonary sites, especially the small bones, is a seldom reported entity even in endemic countries. Moreover, simultaneous involvement of the forearm muscles is a very rare presentation with no such case reported showing concurrent involvement of the two sites. The diagnosis is challenging due to the paucibacillary nature of the disease, a lack of awareness among primary clinicians, and ambiguity in clinical features with other musculoskeletal disorders, especially when there is no pulmonary involvement. Herein, we present a first-of-its-type case of spina ventosa of the left ring finger with a tuberculous abscess in the forearm in a 15-year-old Indian male with no pulmonary seeding. The diagnosis was achieved through a detailed diagnostic workup, which resulted in the detection of Mycobacterium tuberculosis . He was initiated on antituberculous treatment with a remarkable improvement., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yadav et al.)