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Lesser digital fractures of the distal phalanx are generally healed by conservative methods. However, if, after splinting, the affected digit fails to relieve symptoms, surgical intervention may be indicated for definitive treatment. One of these case reports is presented.
Although the typical features of osteoid osteomas are well known, those arising in phalanges are frequently misdiagnosed. This is partly because of their rarity (9% of osteoid osteomas in the Bristol Bone Tumour Registry occur in phalanges), and also because of atypical radiological features. The most common appearance is of an eccentric lesion with soft-tissue swelling and a relative absence of sclerosis, suggesting osteomyelitis.
The post operative iatrogenic hallux varus associates varus, big toe's dorsal flexion and supination. The pathogeny is dominated by musculo-tendinous lack of balance created by the initial operation and excessive exostosectomy. The authors have nineteen times surgically corrected this deformation. The procedure included in all cases, a medial arthrolysis; five times associated with a screwed capito-metatarsal osseous shelf (or graft) (when there was a metatarsal's head maiming); thirteen times associated with a metatarso-phalangeal arthrodesis (in cases of impaired joint surfaces). The authors analyse, besides, without excluding them the other surgical procedures for hallux varus, and particularly tendinous transfers. The results show the necessity of a perfect etiopathogenic analysis of the deformation.
Small areas of discrete radiolucency surrounded by well-defined margins of sclerosis are incidental asymptomatic findings in the proximal phalanges of the feet, usually in young males. Histologic examination of similar lesions discovered in the feet of cadavers shows fat necrosis. Although the etiology of these lesions is as yet unproven, musculoskeletal stress is suggested.
We report on a 2-year-old girl affected by an isolated form of brachydactyly type B (BDB)-like malformation of the limbs consistent with Cooks syndrome (CS). A literature review was carried out in an attempt to delineate the CS clinical spectrum and separate it from BDB. The two conditions can be differentiated on clinical, radiological, and genetic grounds. In particular, CS shows a characteristic pattern of ungueal and phalangeal anomalies. In the hands, all rays are involved to a similar extent with bulbous tips. The feet are generally more severely affected than the hands. Involvement of the nails appears to be a primary feature and not secondary to phalangeal hypo/aplasia. Also, radial and ulnar rays are similarly affected. The CS clinical spectrum is expanded to include ungueal tumor-like lesions, observed in the present patient.
An oblique proximal phalangeal osteotomy is introduced as an alternative to the Akin procedure for the treatment of hallux valgus. It consists of a single oblique osteotomy directed from proximal-dorsal to plantar-distal. A retrospective review of 32 patients who underwent 36 oblique proximal osteotomies is presented. The mean follow-up was 11 months (range, 3 to 21 months). Pre- and postoperative radiographic measurements of the distal articular set angles showed an average correction angle of 12 degrees (range, 7 degrees to 22 degrees; SD = 2.99). Mean range of first metatarsophalangeal joint motion was 82% of the preoperative value when combined with distal metatarsal osteotomy, and 87% of the preoperative value without a distal metatarsal osteotomy. Time to clinical and radiographic healing averaged 5 weeks (range, 4 to 8 weeks). The average amount of phalangeal shortening was 1 mm (range, 0 to 2 mm). There were no delayed or nonunions. Subjective assessment conducted by retrospective review of 19 patients at 6 months postoperatively showed that 17 were completely satisfied (90%), 1 was satisfied (5%), and 1 fairly satisfied (5%). Nineteen would have the surgery again (1 with reservations). Eighteen were very satisfied with appearance and 1 was improved. Fourteen returned to shoe gear at weeks 6 to 8, and 5 returned at weeks 8 to 12. Eighteen were satisfied with pain relief and 1 was improved. The study indicates that the oblique proximal phalangeal osteotomy is an effective, reliable, and technically simple procedure for correction of deformities of the proximal phalanx. The advantages include minimal shortening, ease of adjustability, and a construct conducive to rigid fixation.
The few reported anatomic studies have proved the inconsistency of distal soft-tissue release for hallux valgus correction with both the open (dorsal) and transarticular approaches. Anatomic dissections were performed in 15 fresh-frozen human anatomic lower extremity specimens to evaluate the efficacy of the transarticular soft-tissue release utilizing an arthroscopic blade. The features of the arthroscopic blade, such as continuous cutting surface in all edges, increased length as compared with the No. 15 scalpel blade, and flexibility that permits bending without the likelihood of breakage, substantially increase its efficacy during the transarticular soft-tissue release, allowing for complete release of the lateral sesamoid ligament, lateral metatarsophalangeal capsule, and the adductor hallucis tendon insertion onto the proximal phalangeal base. Based on these observations, the authors recognized the inherent limitations of the transarticular approach for complete adductor release from the lateral sesamoid. Transarticular release including the lateral sesamoid ligament, lateral metatarsophalangeal capsule, and the adductor hallucis tendon insertion onto the proximal phalangeal base utilizing the arthroscopic blade is a versatile, reproducible, safe, and easy technique that should be expected to have decreased morbidity and improved cosmesis compared with the open approach.
OBJECTIVE: To investigate the result of the transplantation of frozen canine phalangeal joint allografts perforated and incorporated with autogenic bone marrow. METHODS: A proximal interphalangeal joint defect of 1.5 cm was prepared at bilateral sides of twenty-four adult healthy out-bred dogs. Three different types of allografts were applied to repair the defects: fresh autogenic phalangeal joints (group A, n = 16), frozen phalangeal joint allografts perforated and incorporated with fresh autogenic bone marrow (group B, n = 16), and frozen phalangeal joint allografts (group C, n = 16). Radiographic and histological study were used to evaluate the survival of transplanted joints. The observation was done 1, 3, 6 and 12 months after operation respectively. RESULTS: Based on the radiographic and histological changes of the transplanted joints, the osteoarthropathy of transplanted canine phalangeal joints could be divided into 3 degrees: mild degeneration, moderate degeneration and severe degeneration. Mild degeneration was observed in group A from 3 to 12 months. Mild degeneration was also found in group B from 1 to 6 months, and the endochondral ossification was obvious within the drilled bony holes. However, some joints in group B underwent moderate degeneration 12 months after operation. Group C joints in the first month had moderate degeneration, which progressed to severe degeneration 3 months after operation. CONCLUSION: Transplantation of frozen canine phalangeal joint allografts perforated and incorporated with autogenic bone marrow can effectively delay the degeneration of transplanted osteoarticular allografts at the early and middle stage.
OBJECTIVES: To compare the biomechanical properties, in full limb preparations, of intact second phalanx and a simulated comminuted second phalangeal fracture stabilized with either two bone plates or a custom Y-plate. STUDY DESIGN: In vitro biomechanical assessment of intact limbs and of paired limbs with a simulated second phalangeal fracture stabilized by one of two fixation methods. Animal Population-Thirteen pairs of equine cadaveric forelimbs. METHODS: A comminuted second phalangeal fracture was created in six paired cadaveric limbs. For each limb pair, the fracture was stabilized with two plates in one limb, and with a Y-plate in the contralateral limb. These limbs and seven pairs of intact limbs were subjected to axial compression in a single cycle until failure. Mechanical properties were compared with a mixed-model ANOVA and post hoc contrasts. Joint contact pressure, screw insertion torque, and final screw torque remaining after mechanical testing were also evaluated for constructs. RESULTS: No significant differences in mechanical testing variables were detected between construct types. However, the Y-Plate construct had significantly greater yield load, yield displacement and yield energy, and failure load and stiffness values than those for intact specimens, whereas the double-plate construct only had greater stiffness than intact specimens. There were no significant differences in joint contact pressures for both constructs. The final screw torque for proximal phalangeal screws was significantly greater for the Y-plate constructs than for double-plate constructs. CONCLUSIONS: The Y-plate was as effective as the double-plate technique for stabilization of simulated comminuted second phalangeal fractures in monotonically tested equine cadaveric forelimbs. CLINICAL RELEVANCE: This investigation supports evaluation of the Y-plate for repair of comminuted second phalangeal fractures in equine patients. Its specific design may facilitate repair of second phalangeal fractures, and may provide increased stability by allowing the proximal fragments of the second phalanx to be fixed with three screws placed through the plate.
The authors present a rather rare case of sarcoidosis in a 12 year old child. Boney involvement constitutes the first manifestation of the condition, with micro-cystic radiological appearance of the second phalanges of both third fingers. The chest X-ray demonstrated glandular and parenchymatous involvement. The diagnosis was histologically confirmed by osseous biopsy. The authors compare their case with other previously published cases.
Water, lipid, and mineral composition were determined for metacarpals, phalanges, livers, and antlers from 219 free-ranging white-tailed deer (Odocoileus virginianus) collected on six properties in East Feliciana Parish, Louisiana (USA) to provide baseline data and to identify sources of composition variation. Metacarpal and phalangeal composition varied primarily with deer age; liver composition varied with deer sex.
When conservative treatment in the management of the painful rheumatoid forefoot fails, surgery should be advocated. The aim is to relieve the sole from pressure on the metatarsal heads, which causes callosities on and pain in the forefoot. Various surgical procedures have been described, but they have in common to replace or remove the fat pad under the metatarsal phalangeal joints, to resect the metatarsal heads and, in doing this, restore the metatarsal ends to a flat arc. For if the intermediate metatarsals are left too long, new pressure points may develop, with ensuing pain. In this investigation a 4 1/2-year follow-up is presented of 32 patients operated on with metatarsal head resection in 59 feet. Twenty-two patients representing 39 feet were very satisfied, whereas 8 patients representing 15 feet were dissatisfied. Walking ability improved considerably; standing on toes improved; muscle power of toes improved. Despite attempting to maintain the metatarsal arc as a flat curve, this proved to be uneven in 25 feet, but did not jeopardize the results. The complications were minor and did not influence the final results. These, however, were decidedly influenced by the functional class of the patient at the time for investigation. Surgical management of the painful rheumatoid forefoot appears to be a recommendable procedure.
We present a case of an 80-day-old boy with major anomalies consistent with polyoligodactyly/imperforate anus/vertebral anomalies (PIV) syndrome. In addition, he had facial abnormality, tetrapolyhypodactyly, and sacral meningocele. Polydactyly was of postaxial and central types, and all the distal phalanges were absent. The association of such anomalies enabled pinpointing of the development of this complex anomaly from the 4th to the 6th weeks of the embryonic phase. This condition is extremely rare, and the estimated incidence is 3 in one billion.
The authors present a 51-year-old patient with clinical signs of acrodermatitis continua suppurativa of the toes. Since histological findings failed to unambiguously support the diagnosis of acrodermatitis continua suppurativa, immunohistology was performed. The results showed intercellular epidermal fluorescence. The subsequent clinical picture (vegetating formation), the repeated histological examination (suprabasal cleft and eosinophilia), as well as the data of immunohistological findings supported the diagnosis of pemphigus vegetans Hallopeau. The patient was treated successfully with a combination of cyclosporine-A and low-dose steroid therapy. The case is of special interest, because there is only a single publication about phalangeal and nail involvement in Hallopeau's type pemphigus vegetans in the dermatological literature according to our knowledge.
Multiple congenital eye and hand anomalies occurred in a young female born to normal but consanguineous parents. Both eyes were microphthalmic with severe corneal, iris lens pathology. Ultrasonography revealed multiple echos from the vitreous. The ocular findings are suggestive of retinal dysplasia. A skeletal dysplasia, presenting as distal phalangeal hypoplasia, was found in both hands. There was no history of intrauterine exposure to drugs. This appears to be a unique association of congenital malformations, without other systemic involvement. Diagnostic and genetic implications are discussed.
Dislocations and fracture-dislocations of the tarsometatarsal joints, fractures of the base of the fifth metatarsal bone, fractures of the shafts and necks of the metatarsal bones, dislocations of the metatarsophalangeal joints, fractures of the phalanges and dislocations of the interphalangeal joints each have a specific mechanism of injury, characteristic diagnostic feature, and requirement for treatment. Only by an accurate diagnosis established by careful physical and roentgenographic examination can complications be avoided.
Osteochondroma, a benign tumor of bone that may penetrate the skin is rarely recognized by the dermatologist. We report two cases of osteochondroma of the distal phalanges with cutaneous penetration, and discuss the clinical, histologic, and radiographic features that allow rapid identification of this lesion. Furthermore, we emphasize the importance of total tumor excision, including adequate treatment of the underlying bone, to prevent recurrence of the lesion.
The effects of nifedipine (40-100 mumol/kg), nitrendipine (40 and 80 mumol/kg), hydralazine (381 and 763 mumol/kg), felodipine (12 mumol/kg), and the pharmacologically inactive first-step metabolite of felodipine, H152/37 (80 mumol/kg) were studied in rabbits (New Zeeland White) after oral administration on day 16 of gestation. The vasodilating drugs--nifedipine, nitrendipine, felodipine, and hydralazine--all induced digital defects in the fetuses. The defects consisted of a reduction, absence, or abnormal structure of the distal phalanx of especially the fourth digit on the hind paw(s). Histologically, a disturbed differentiation of the cartilage, and secondarily also of the ossification centre and joint structure of the distal phalanx, was observed. In contrast, no digital abnormalities were observed after administration of vehicle or H152/37. The findings that vasodilators with different structures, like dihydropyridines and hydralazine, induced the same type of digital defects strongly suggest that the observed phalangeal defects are secondary to pharmacological action, and not related to chemical structure. A decrease in uteroplacental blood flow, caused by excessive hypotension, is discussed as the most probable mechanism underlying the observed defects.