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PubMed1992

Hand bone growth during puberty and in Turner's syndrome.

Measurements were made on hand radiographs of normal girls and patients with Turner's syndrome. Normal girls going through puberty display increases in hand bone dimensions which are highly correlated with height and bone age. We report such changes in length and total bone width of metacarpal II (MCII) and proximal phalanx II (PPII), and in combined cortical thickness and cortical area of MCII. For the relative cortical area, the correlations are less pronounced. In comparison with controls of similar height, MCII of patients with Turner's syndrome has greater length and total bone width and combined cortical thickness. Turner patients treated with sex steroids undergo skeletal maturation as well as a rise in MCII relative cortical area (a measure of bone density), but fail to show a commensurate increase in MCII length and in MCII cortical area (a measure of bone mass). It is concluded that in untreated Turner patients, bone density as well as bone mass are normal for the (retarded) bone age, and that sex steroids which promote skeletal maturity likewise raise bone density but not bone mass. The (relative) insensitivity of bone mass and the lack of accelerated statural growth in response to administered sex steroids may be inborn characteristics of the Turner skeleton.

Adolescent↗
PubMed2005

Monte Carlo simulation of neutron irradiation facility developed for accelerator based in vivo neutron activation measurements in human hand bones.

The neutron irradiation facility developed at the McMaster University 3 MV Van de Graaff accelerator was employed to assess in vivo elemental content of aluminum and manganese in human hands. These measurements were carried out to monitor the long-term exposure of these potentially toxic trace elements through hand bone levels. The dose equivalent delivered to a patient during irradiation procedure is the limiting factor for IVNAA measurements. This article describes a method to estimate the average radiation dose equivalent delivered to the patient's hand during irradiation. The computational method described in this work augments the dose measurements carried out earlier [Arnold et al., 2002. Med. Phys. 29(11), 2718-2724]. This method employs the Monte Carlo simulation of hand irradiation facility using MCNP4B. Based on the estimated dose equivalents received by the patient hand, the proposed irradiation procedure for the IVNAA measurement of manganese in human hands [Arnold et al., 2002. Med. Phys. 29(11), 2718-2724] with normal (1 ppm) and elevated manganese content can be carried out with a reasonably low dose of 31 mSv to the hand. Sixty-three percent of the total dose equivalent is delivered by non-useful fast group (> 10 keV); the filtration of this neutron group from the beam will further decrease the dose equivalent to the patient's hand.

Aluminum↗
PubMed2003

Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker.

OBJECTIVE: To investigate whether hand bone mineral content (BMC) measurement is an outcome measure for RA and whether the early changes in hand BMC predict functional disability. METHODS: Tender and swollen joints in hands and body, HAQ score, Larsen score on hand radiographs, serum CRP, and hand BMC measurement by DXA were studied every six months for five years in 40 patients with early RA. At the final visit, patients completed the SF-36 and Duruoz hand function questionnaires. RESULTS: All patients completed two years and 29 completed five years' follow up. Hand BMC worsened over the first three years (percentage loss from baseline: mean (SD) -5.5 (7.2), -7.5 (8.4), -9.8 (9.4)) and stabilised over last two years (-9.9 (8.8), -10 (7.8)). Baseline disease activity and function correlated with hand BMC loss at five years (swollen joints in hands: r=-0.38, p=0.043; swollen joints in body: r=-0.47, p=0.01; HAQ: r=-0.52, p=0.004). Percentage change in hand BMC over five years correlated with SF-36 physical function (r=0.61, p<0.01), hand function (r=-0.64, p<0.01), HAQ score (r=-0.63, p<0.01) at five years. Relative risk of bad hand functional outcome at five years was significantly higher for patients with hand BMC loss of >/=1.17 g (smallest detectable difference) than for patients with less bone loss within the first six months (OR=6.9, 95% CI 1.3 to 34.5, p<0.02). CONCLUSION: Early loss of hand BMC in patients with RA is a composite marker of disease activity and functional status and can predict poor functional outcome.

Absorptiometry, Photon↗
PubMed2000

Relation between grip strength and hand bone mineral density in healthy women aged 30-70.

AIM OF STUDY: To determine the site-specific relationship between grip strength and hand bone mineral density (BMD) measured with dual energy x-ray absorptiometry (DXA) in healthy women. The correlation of hand BMD and BMD at axial sites has also been assessed. METHOD: Twenty-nine healthy housewives, aged 30-70, were included in the study. Women were grouped according to their menopausal status (12 premenopausal and 17 postmenopausal). Grip strength of the dominant hand was measured using a Jamar dynamometer. BMD of the antero-posterior spine, femoral neck, trochanter, and Ward's triangle were measured with DXA. For the hand BMD measurements, the analysis software, which was modified from the software of small animals and developed for hand BMD measurements, was used. RESULTS: Hand BMD moderately correlated with grip strength in postmenopausal women. There was no significant correlation between grip strength and hand BMD in premenopausal women. Significant positive correlations were determined between the hand BMD and BMD at axial sites. CONCLUSION: Grip strength may be an independent indicator of hand BMD in postmenopausal women, and also a site-specific relationship. Hand BMD measurements may indirectly reflect the BMD of axial sites especially in postmenopausal women.

Absorptiometry, Photon↗
PubMed2001

Prospective X-ray densitometry and ultrasonography study of the hand bones of patients with rheumatoid arthritis of recent onset.

OBJECTIVE: Bone demineralization observed in early rheumatoid arthritis is not easily measured. To measure bone loss and to discriminate between rheumatoid arthritis and other rheumatic diseases, we used two methods: dual-energy X-ray absorptiometry and ultrasonography. METHODS: From a population-based recruitment, 32 patients with early peripheral polyarthritis (median disease duration: 4 months) were studied. Clinical, laboratory, functional, hand-bone assessments were made at the entry an at months 6 and 12. Bone X-ray densitometry measurements were made on 16 areas of the hand. Speed of sound was measured across the proximal phalanges of the four fingers. X-rays of both hands were scored according to the modified Sharp's score. At 12 months, patients were classified as rheumatoid arthritis (N = 15; 9 F) or as other rheumatic diseases. RESULTS: We found: 1) significantly decreased bone mineral density (BMD) of the whole hand, in the rheumatoid arthritis group versus the other rheumatic diseases group, at 6 and 12 months (P < 0.05); 2) no significant decrease of bone mineral density (BMD) in other areas in the rheumatoid arthritis group; 3) no significant change of ultrasounds in either group; and 4) no significant correlation between the decrease of BMD in the rheumatoid arthritis group and clinical, biological or radiologic parameters, except for IFNgamma, whose production in whole blood cell culture was lower at entry in the rheumatoid arthritis group. CONCLUSION: DEXA bone assessment in rheumatoid arthritis was able t detect bone loss in the whole hand at 6 months.

Absorptiometry, Photon↗
PubMed2002

An accelerator based system for in vivo neutron activation analysis measurements of manganese in human hand bones.

Manganese (Mn) is an essential nutrient for growth and development. Unfortunately, overexposure can lead to neurological damage, which is manifested as a movement disorder marked by tremors. Preclinical symptoms have been found in populations occupationally exposed to the element, and it is suggested that in late stages of the disorder, removing the Mn exposure will not prevent symptoms from progressing. Hence, it is desirable to have a means of monitoring Mn body burden. In vivo neutron activation analysis (IVNAA) is a technique which allows the concentration of some elements to be determined within sites of the body without invasive procedures. Data in the literature suggests that the Mn concentration in bone is greater than other tissues, and that it may be a long term storage site following exposure. Therefore, using the McMaster KN-accelerator to produce neutrons through the 7Li(p,n)7Be reaction, the feasibility of IVNAA for measuring Mn levels in the human hand bone was investigated. Mn is activated through the 55Mn(n,gamma)56Mn reaction, and the 847 keV gamma rays emitted when 56Mn decays are measured outside the body using NaI(Tl) detectors. An optimal incident proton energy of 2.00 MeV was determined from indium foil and microdosimetry measurements. Hand phantom data suggest a minimum detectable limit of approximately 1.8 ppm could be achieved with a reasonably low dose of 50 mSv to the hand (normal manganese levels in the human hand are approximately 1 ppm). It is recommended the technique be developed further to make human in vivo measurements.

Bone and Bones↗
PubMed2003

Predictors of radiological progression and changes in hand bone density in early rheumatoid arthritis.

OBJECTIVE: To identify predictors for radiological and functional outcome and bone loss in the hands in early rheumatoid arthritis (RA) during the first 2 yr of disease and to study the relationship between these variables. METHODS: An inception cohort of consecutively recruited patients was examined at baseline and after 12 and 24 months using X-rays of hands and feet, clinical [28-joint count, Health Assessment Questionnaire (HAQ), global visual analogue scale (VAS), grip strength] and laboratory (erythrocyte sedimentation rate, C-reactive protein, markers of bone formation and resorption) measurements and dual-energy X-ray absorptiometry measurements of the hands. RESULTS: Joint destruction increased significantly during the study, with the Larsen score at baseline as the strongest predictor. Radiological progression and bone loss over 24 months were significantly retarded in patients responding to therapy. The effects of the shared epitope and initial high inflammatory activity on radiological progression were overridden by the therapeutic response. Radiological progression correlated significantly with bone loss. Global VAS, Larsen score and HAQ at inclusion significantly predicted change in HAQ over time. CONCLUSIONS: Radiological progression and bone loss were retarded by early therapeutic response. Bone loss was related to radiological progression.

Absorptiometry, Photon↗
PubMed2005

Hand bone loss in early undifferentiated arthritis: evaluating bone mineral density loss before the development of rheumatoid arthritis.

OBJECTIVES: (1) To examine the change in regional bone mineral density (BMD), including the hands, and assess its role as a predictor of outcome in patients presenting with an early undifferentiated inflammatory arthritis; (2) to examine for associations with the changes in hand BMD. METHODS: 74 patients with undifferentiated hand arthritis of less than 12 months' duration were examined at baseline and then at three, six, and 12 months follow up, including BMD measurement of the femoral neck, spine (L2-4), and the whole hands using dual energy absorptiometry (DXA). RESULTS: During the study, 13 patients were diagnosed as having rheumatoid arthritis, 19 as having inflammatory non-rheumatoid joint disorders, and 42 as having non-inflammatory joint disorders. At the femoral neck and lumbar spine no significant bone loss was seen in any of the three subgroups. At the 12 months follow up the mean (95% confidence interval) hand BMD loss in the patients with rheumatoid arthritis was -4.27% (-1.41 to -7.13); in the inflammatory non-rheumatoid group, -0.49% (-1.33 to +0.35); and in the non-inflammatory joint disorder group, -0.87% (-1.51 to -0.23). In a multivariate linear regression model (including age, rheumatoid factor, mean C reactive protein, mean HAQ score, and cumulative glucocorticoid dose), only mean C reactive protein (p<0.001) and rheumatoid factor (p = 0.04) were independently associated with change in hand BMD during follow up. CONCLUSIONS: Hand DXA provides a very sensitive tool for measuring bone loss in early rheumatoid arthritis and may be useful in identifying patients at high risk of developing progressive disease. Further studies are needed to evaluate the role of hand bone loss as a prognostic factor and outcome measure in rheumatoid arthritis.

Absorptiometry, Photon↗
PubMedDate not supplied

[Diagnostics of the skeletal massiveness and human somatotype using hand bones].

The skeleton massiveness (SM) and the somatotype of human constitution were determined on the basis of osteometry of bones of carpal and metacarpal bones (MB) and of phalanxes. Seventy male and 13 female skeletons from the collection of the chair for anthropology, Moscow State University, were investigated. Described are the results of examinations of 8 carpal bones made according to 3 signs (length, width, and height), and of 5 metacarpal bones made according to 4 signs (length, base and head width, and base height); investigation findings of finger phalanxes (in full) are also presented. Methods of current multidimensional statistics were used within the case study, i.e. related with the key components--for SM specification and the discriminative analysis--for constitution specification. The SM determination accuracy according to type A was 40%, according to type B--80%, according to type C--37.5% and according to type D--52.9%. The classification accuracy of constitutions by carpal bones was 50.0%, by MB--46.4%, and by MB plus finger phalanxes--48.1%. It is pointed out that it was for the first time that the elaborated quantitative criteria of osteometry of hand bones could be used in the expertise practice for the purpose of personality identification by osseous remains.

Adult↗
PubMed2003

Quantitative genetic study of radiographic hand bone size and geometry.

Despite the obvious epidemiological significance of bone size (BS) and geometry (BG) traits as risk factors for osteoporotic fracture, very little is still known concerning the extent of their genetic determination. In the present paper we report the results of quantitative genetic analysis of a number of BG and BS indices, as well as of BMD measurements, obtained on a large pedigree-based sample (296 nuclear families, 1208 individuals) of plain hand radiographs. The families studied were all ethnically Caucasians (Chuvasha) living in small villages along the Volga River (Russia). The sample consisted of 636 men and 572 women, aged 18-91 years. To assess hand bone size we used the outcome of principal component analysis conducted on 48 measurements of metacarpal bones and proximal phalanges (PC-BS). Two BG indices, average metacarpal cortical index and breaking bending resistance index (BBRI), also measured on metacarpal and proximal phalanges were used. Again the outcome of the principal component PC-BBRI was examined in the genetic analysis. PC-BS measurements strongly correlated with body length (r = 0.75, P < 0.001) and weight (r = 0.39, P < 0.001), suggesting that they indeed reflected hand skeleton size. Familial correlations for all studied traits, adjusted for covariates (sex, age, etc.), were all highly significant statistically. For example, parent/offspring correlations ranged between 0.248 (P < 0.001) for phalangeal BMD and 0.385 (P < 0.001) for PC-BBRI. Maximum likelihood estimates of the variance component analysis confirmed these results, indicating that approximately 58 to 66% of the residual variance of the studied traits was attributable to genetic effects. Bivariate analysis clearly revealed that while genetic variation of the phalangeal BMD was independent of the genetic effects influencing hand BS and BG, the latter two were strongly interrelated. A substantial proportion of PC-BS and PC-BBRI variation was due to shared genetic (r(G) = 0.468 +/- 0.063) and environmental (r(E) = 0.704 +/- 0.052) factors.

Adolescent↗
PubMed1996

[AO external mini-fixateur for the hand bones. Surgical technique and initial experiences].

Fractures of the hand and fingers showing comminution or associated soft-tissue lesions are best treated with external fixation. In contrast to other systems, the new AO mini-external fixator enables less bulky unilateral fixation facilitating early mobilisation and the special design of the double clamps allows preliminary intraoperative stabilisation with only one wire in each fragment. Modular fixation makes free placement of the wires possible with accommodation of bone and soft tissue lesions. Twenty patients with hand injuries showed uneventful soft tissue healing and there were no cases of non-union in 19 metacarpal and phalangeal fractures.

Adolescent↗
PubMed1991

[Simplification of osteosynthesis procedures of the hand bones using newly developed mini-osteosynthesis].

From unsatisfactory results in fractures in the hand treated with K-wires or other osteosynthesis we felt the need to develop new material for osteosynthesis. Our goal was to simplify the operative procedure, to enable exact anatomical reposition to avoid or reduce splinting in order to prevent adhesions and secondary operations. Further more to be able to reduce and stabilise small fragments. After more than 4 years of experience with our material in more than 200 osteosynthesis we can conclude, that our goal has been accomplished to a great deal. We would like to present this procedure.

Bone Plates↗
PubMed1975

Improved roentgenologic diagnosis of osteomalacia by microradioscopy of hand bones.

Microradioscopic study of metacarpals in 24 osteomalacic and 34 osteoporotic patients revealed excessive intracortical resorption (striations) in approximately 60 percent of patients suffering from osteomalacia, but in none of the osteoporotics. Phalangeal periosteal resorption was found less frequently in osteomalacia than metacarpal striations, and was absent in osteoporotics. On the other hand, quantitative evaluation of cortical thickness, percent cortical area, bone mineral mass, and density did not show any clear differences between the two study groups. It is concluded that the differential diagnosis between osteomalacia and osteoporosis may be considerably improved by microradioscopy of hand bones.

Adult↗
PubMed1998

[AO-classification of fractures of the hand bones].

The AO classification of fractures has gained worldwide acceptance regarding usefulness of typification, therapeutic consequences and assessment of results. Following these principles, we developed a classification draft for fractures of the hand, using an alphanumerical code.

Fracture Healing↗