Absence of phalanges and toenails.
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Child, Preschool↗
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Free combined thin wrap-around flap with a second toe proximal interphalangeal joint transfer for reconstruction of the thumb.
The combined thin wrap-around flap from the big toe and the proximal interphalangeal joint of the second toe is characterized by (1) a single vascularized joint, which is used to preserve the second toe with a free iliac bone graft, (2) a thin wrap-around flap, which allows the pulpal fatty tissue on the remaining bone of the big toe to be retained and accept a skin graft, (3) a wrap-around flap with a partial distal phalangeal bone, and (4) a microplate for firm fixation at the proximal bone union and early joint motion. The advantages of this method are (1) the cosmetic appearance is excellent with use of the thin wrap-around flap; (2) there is joint motion in the reconstructed thumb with strong pinch and vice pinch; (3) the vascularized joint with a microplate allows for early postoperative motion; (4) bone grafting from another donor site is unnecessary; (5) bone growth is possible in children with open epiphyses; and (6) the big and second toes are preserved with minimal donor-site morbidity. This method is indicated for thumb losses at a level distal to the metacarpophalangeal joint or at the level of the proximal phalanx.
Adult↗
Autosomal dominant microcephaly with normal intelligence, short palpebral fissures, and digital anomalies.
We describe a family segregating an autosomal dominant mutation producing a syndrome comprising microcephaly with normal intelligence and short palpebral fissures together with variable signs including thumb hypoplasia, shortness of the middle phalanges of the second and fifth fingers, small feet, a gap between the first and second toes, and mild syndactyly of the toes or fingers. A characteristic radiologic finding in our family is thinning of the proximal end of the first metacarpal and shortening of that metacarpal. The severity of these findings was asymmetric in our patients. This syndrome is similar to patients described by Brunner and Winter [1991: J Med Genet 28: 389-394], Feingold [1975: Synd Ident 3:16-17, 1978: Hosp Prac 13:44-49], and König et al. [1990: Dysmorphol Clin Genet 4:83-86].
Child, Preschool↗
Potential method of optimizing the klapskate hinge position in speed skating.
Acceptance of the klap speed skate was fully realized on the world speed skating scene in 1997. However, one of the most important unknowns regarding the klapskate was the positioning of the point of foot rotation (pivot point), which is believed to play an important role in optimizing klapskate performance. The purposes of this study were to explore the ankle, knee, and hip joint mechanical changes that occurred when the pivot point location was modified, and to determine whether maximal ankle torques provide predictive ability as to where the optimal pivot point positioning is for a skater. We tested 16 proficient skaters at three pivot point PP) locations, ranging from just in front of the metatarsal-phalangeal joint to just in front of the first phalangeal joint. Of the 16 skaters, 10 were tested at a fourth position; tip of the toe. Push phase kinetics and kinematics were measured on a modified slide board. The optimal PP for each skater was defined as the position that allowed him to generate the most total push energy. Maximum voluntary static torque measures of the ankle and knee were collected on a Biodex dynamometer. Overall, anterior pivot point shifting led to a significant increase in ankle energy generated and a decrease in knee energy generated, with no significant change at the hip joint. We found no significant correlations between the static strength measures and the skaters' optimal pivot points.
Adolescent↗
The 12p trisomy syndrome.
Trisomy for the short arm of chromosome number 12 was diagnosed (by a G-banding method) in a girl with multiple congenital defects. Her mother and two sisters showed a balanced translocation 46,XX,rcp(12;21)(p11;p11), so, the affected girl was the result of a maternal adjacen t-1 meiotic segregation with a karyotype 46,XX,der21,rcp(12;12)(p11;q11)mat. Another sister decreased at 3 yr of age showed similar phenotypical features and was considered also affected although no karyotype studies were performed. Both affected cases were compared with a previous one and the concordant characteristics allowed the individualization of the following syndrome: severe mental retardation, peculiar flat facies with prominent checks, epicanthic folds, broad and irregular implantation of the eyebrows, broad and flat nasal bridge with short and narrow nose, anteverted nostrils and large philtrum, broad and prominent lower lip, low set ears with folded helix, prominent anthelix and deep concha, "spade" shape fingers (sharp-pointed distal phalanges) with shortness of the fifth, bilateral genu valgum, slightly increased space between first and second toes, secral dimple, generalized hypotonia and hyporeflexia of knees and ankles, nistagmus, retarded and dysrythmic bone age, simian creases or equivalent and distal axial triradii.
Abnormalities, Multiple↗
[Significance of autonomic variants of the development of phalanges of the foot in the diagnosis of their fractures].
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Child↗
The choice of procedure following thumb amputation.
The attributes that make the thumb unique are position, stability, strength, length, motion, sensibility, and appearance. Of these qualities, the first four must be present to an acceptable extent for function to approach normality, while the latter three are very desirable but not essential. Reconstructive alternatives following amputation can be considered in four broad groups: where the length is acceptable but the covering is poor; subtotal amputation, where length is equivocal; total amputation with the basal joint preserved; and total amputation with the basal joint destroyed. In the first group, soft-tissue cover can be improved by local flaps with or without a neurovascular pedicle or by microvascular free pulp transfer. In the second group, metacarpal lengthening by distraction, with or without phalangization, may give adequate length. In total amputations, one may choose osteoplastic reconstruction, pollicization, or toe-to-hand transfer. Which solution is selected depends on the level of the amputation, the presence and nature of injuries to other digits, occupational and social factors, and the availability of tissues.
Amputation, Traumatic↗
Dactylitis, a term for different digit diseases.
Dorland's Illustrated Medical Dictionary gives the following definition of dactylitis (deltaalphachitauupsilonlambdaomicronsigma = digit): 'inflammation of a finger or toe'. Although any inflammatory process involving the fingers or toes may be called dactylitis, the term has entered in current use only in some well-defined entities. These differ in the involved tissue of the digit and in the type of involvement. Tuberculous dactylitis is the variant of tuberculous osteomyelitis affecting the short tubular bone of the hands and feet. Radiographs typically show a central, lytic, cystic, and expansive lesion known as spina ventosa. Syphilitic dactylitis is a manifestation of congenital syphilis. Radiological findings mimic those of tuberculous dactylitis but the involvement is bilateral and symmetric. Sarcoid dactylitis is due to typical non-caseating granulomas invading the phalanges and the adjacent soft tissue. Blistering distal dactylitis is an infection of the anterior fat pad on the volar surface of the distal portion of a single finger or more rarely a toe, mostly caused by group A beta-haemolytic streptococci. Sickle cell dactylitis, also known as 'hand-foot syndrome', is due to localized bone marrow infarction of the carpal and tarsal bones and phalanges. Spondyloarthritis dactylitis, also called 'sausage-like' digit, is a diffuse painful swelling of the fingers and toes. Recent ultrasonography (US) and magnetic resonance imaging (MRI) studies on both finger and toe dactylitis have established that dactylitis is due to flexor tenosynovitis and that the enlargement of the joint capsule is not an indispensable condition for the 'sausage-like' feature. There is no evidence of enthesitis of flexor digitorum tendons and joint capsule.
Fingers↗
Sixty cases of partial or total toe transfer for repair of finger losses.
Our experience with partial or total toe transfers for the reconstruction of finger deficits is presented. Sixty-one toes were transferred to reconstruct finger deficits in 60 patients. The transfers from the big toe consisted of 3 vascularized whole-nail grafts, 4 onychocutaneous flaps which included the nail and a skin flap from the toetip, 16 thin osteo-onychocutaneous flaps, 4 wrap-around flaps, and 3 combined wrap-around and dorsalis pedis flaps. The transfers from the second toe consisted of 6 trimmed toetips including the nail, 16 second toes, 1 combined second toe and a dorsalis pedis flap, and 1 second toe and third toe. The other transfers mainly consisted of other flaps, including a hemipulp flap and a first web space flap. Regarding the transfers from the big toe, vascularized nail grafts and onychocutaneous flaps were found to be most suitable for the treatment of total nail loss, thin osteo-onychocutaneous flaps for distal phalangeal loss of the thumb, wrap-around flaps with a vascularized iliac bone graft for thumb loss above the metacarpal joint, and the combined wrap-around and dorsalis pedis flaps for a total thumb deficit. Regarding the transfers from the second toe, the trimmed toetips including the nail were most suitable for claw nail deformities, the second toe was most suitable for finger loss except for the thumb with the proximal interphalangeal joint, and the combined second toe and dorsalis pedis flap was most applicable for a total thumb deficit including thenar skin loss.
Adult↗
Congenital crossover fifth toe correction with soft tissue release and cutaneous Z-plasty.
Congenital overriding of the fifth toe causes symptoms in approximately half of all patients. The results of three patients treated with a simpler procedure involving metatarsal phalangeal capsular release dorsally and medially, oblique lengthening of the extensor tendon, and Z-plasty of the skin is reported. At an average of 33 month follow-up, no recurrence is noted with this simple procedure.
Adolescent↗
Bilateral symmetrical osteomyelitis of phalanges complicating typhoid fever.
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Child↗
[Tissue engineering of the phalanx and phalangeal joint].
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Animals↗
Variation in extension of the metacarpo-phalangeal and interphalangeal joint of the thumb.
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Fingers↗
Ruvalcaba syndrome: autosomal dominant inheritance.
A kinship is described in which nine individuals in four generations were affected with the Ruvalcaba syndrome including postnatal growth retardation, an oval face with a high forehead, antimongoloid slant of palpebral fissures, small beaked nose with hypoplastic nasal alae, small downturned mouth with thin vermilion borders, pointed chin, and short fingers and toes. Less frequently seen were osteochondritis of the lumbar vertebral bodies, cone-shaped epiphyses of the phalanges, and narrow diaphyses of the metacarpals and metatarsals. None of the affected individuals was mentally retarded. The propositus, a 3-year-old boy, and his mother were typically affected, while his 8-month-old sister, the 55-year-old maternal grandfather, and his 46-year-old younger sister had several of these manifestations. Information on the remaining four affected relatives was incomplete. The syndrome was transmitted in a dominant fashion with variable expressivity. There were two instances of male-to-male transmission. This effectively ruled out X-linked inheritance. The transmission of the syndrome in three other reported pedigrees was also compatible with autosomal dominant inheritance with variable expressivity and incomplete penetrance.
Abnormalities, Multiple↗
CHILD syndrome caused by a deletion of exons 6-8 of the NSDHL gene.
The X-linked dominant CHILD syndrome (congenital hemidysplasia with ichthyosiform nevus and limb defects) is a rare developmental defect characterized by a strictly lateralized inflammatory nevus. In the majority of cases, the right side of the body is affected. Ipsilateral hypoplastic lesions may involve the brain, skeletal structures, lungs, heart or kidneys. We describe a case of CHILD syndrome involving the left side of the body. Absence of metacarpal, metatarsal and phalangeal bones of the left hand and foot resulted in oligodactyly, with only 3 fingers and 1 toe. An ipsilateral inflammatory epidermal nevus with hyperkeratosis, parakeratosis, acanthosis and perivascular lymphohistiocytic infiltrate was strictly confined to the left half of the patient's body. The phenotype was shown to be associated with a deletion of exons 6-8 of the X-linked NSDHL gene, confirming that CHILD syndrome is due to loss of function of an enzyme involved in cholesterol biosynthesis.
3-Hydroxysteroid Dehydrogenases↗
[The Sixtine metatarsophalangeal prosthesis at first glance. Preliminary results in 74 cases].
The Sixtine prosthesis is a metallic, hemiconical, flat concave, metatarsophalangeal interposition prosthesis, with a rim on the phalangeal end, with a lateral capsular fixation or a temporary fixation by axial pinning. Seventy-four cases using a Sixtine prosthesis were reviewed with a minimum follow-up of 2 years. The range of motion was improved (+12.4 degrees), as was the phalangeal valgus (18.2 degrees for 30.2 degrees), but weight bearing on the ventral side of the first toe was very often lost in spite of the complete preservation of the flexor hallucis brevis. The complication rate was 9.5% with 8% subluxations, which do not influence the final result. The comparison of patients who kept the prosthesis, and of patients in whom the prosthesis was systematically retrieved after one year, shows that the prosthesis may be left in place and that retrieval is only indicated in cases of complications or subluxation.
Adult↗
Free vascularized osteoonychocutaneous flap for reconstruction of the distal phalanx of the fingers.
The "twisted toe flap" offers a solution for reconstruction of the distal phalanx of the fingers; however, a major problem with this method is that the second donor toe must be sacrificed. Two clinical cases are reported in which free vascularized "osteo-onychocutaneous" flaps modified wrap-around flaps were successfully used. The use of the free vascularized osteo-onychocutaneous flap is suggested as a superior method of reconstruction for treating distal phalangeal loss in the fingers.
Adolescent↗
[Hallux valgus treated by shortening of the first phalanx with trans-epiphyseal impaction and adductor plasty. Apropos of 49 cases with 5-years follow-up].
PURPOSE OF THE STUDY: 49 cases of hallux-valgus were treated by a shortening of the phalanx with impaction according to the technic described by Regnauld, associated with a plasty of the adductor. Patients were evaluated with a follow-up greater than 5 years. MATERIAL AND METHODS: 32 female and 5 male patients were treated. 63 per cent patients were between 30 and 60 years old. The preoperative average of metatarsus varus was 12 degrees 1. The length of first metatarsal was inferior to the second in 30 cases. The preoperative average of first phalange valgus was 30 degrees. Every operated foot had an Egyptian morphotype. Sesamoids were consistently dislocated. Associated lesion were: 19 flat feet, 10 round fore-feet, 9 clinodactylies treated during the same procedure. RESULTS: They were evaluated according 3 Groulier's criteria: the correction of deformation, static disturbances, and professional activities. The phalangeal valgus was corrected in 37 cases (72 per cent). 33 feet were painless (67 per cent). The dorsal flexion of the first toe was superior to 60 degrees in 38 cases (77 per cent). Metatarsus varus was consistently reduced. 2 permanent metatarsalgia and 4 plantar corns persisted. 76 per cent of operated patients were able to wear shoes normally with a normal perimeter of walking. At X-ray examination, the head of first metatarsal was unchanged in all cases. The joint space was normal in 39 cases (79 per cent). The base of first phalanx was normal in 25 cases (51 per cent). 37 feet had centered sesamoïds. In total, we noticed: 37 very good and good results (72 per cent), 8 moderate results (17 per cent), bad results (9 per cent). DISCUSSION: The operative technic gives a stable shortening of the first phalanx without material and allows the early weight bearing. The abductor of the great toe is a stronger muscle than adductor, allows rotational correction and the alignment of the first phalanx on the first metatarsal. We agree with criteria of bad prognosis proposed by Groulier: age, valgus flat foot, the duration and the importance of deformation, the presence of osteoarthritis. CONCLUSION: The abductor plasty and soft tissue operation contributes to the durable correction of hallux valgus. Shortening must preserve the vascularization of the proximal end of the phalangeal. This operation should be reserved for young patients, without signs of articular cartilage degeneration and having an Egyptian foot.
Adult↗