Acrodysostosis with 5 alpha reductase deficiency: an unusual association.
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3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
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Results for “Hand Deformities”
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Clinical evaluation of irreversible data compression for computed radiography of the hand.
We evaluated the clinical utility of high data compression for computed radiography (CR) of the hand. Paired original and compressed CR images were obtained using an FCR 9000 system in 35 patients with various abnormalities of the hand. For the paired original and compressed images, we compared the depiction of the bone cortex, bone trabeculae, soft-tissue, and the margin of the abnormalities. The overall impressions for detectability of the abnormalities and for diagnostic capability were also evaluated. Poorer image quality of the compressed images was noted for most of the structures, but there was no significant difference between the original and compressed images as for the overall impressions for detectability of the abnormalities or for diagnostic capability. We conclude that a high data compression may be clinically acceptable with caution in radiography of the hand.
Female↗
[Extensor tendon injuries of the hand].
The treatment of extensor tendon injuries of the hand is based on Verdan's division of the different sections into eight zones. Taking the anatomic characteristics of those zones into consideration, good functional results can be achieved in most cases by differentiating between indications for operative or conservative treatment. The most frequent extensor tendon injury of the hand is the closed tendon rupture over the DIP joint. In almost all cases it can be completely cured by immobilization for at least 8 weeks. Open extensor tendon injuries on the other hand require surgical therapy. This paper gives a clearly arranged overview of the different therapeutic options.
Adult↗
[Hand surgery in German orthopedics].
The intention of this report is to present an overview of the development of hand surgery and its status in German orthopedics. An important role was played by orthopedics in the development of hand surgery: many insights and classifications in this field originate from orthopedic surgeons and retain their validity in this century. In the past few decades, traumatologists and plastic surgeons have become increasingly active in the field of hand surgery and have added to their surgical repertoire some fields formerly regarded as part of classic orthopedics, e.g., correction of malformations of the hand. Although microsurgical techniques of hand surgery were primarily developed by plastic surgeons, the past should nevertheless motivate all orthopedists to continue considering hand surgery the "pearl of orthopedics" in the future.
Germany↗
MR imaging in longitudinal epiphyseal bracket in children.
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Child, Preschool↗
Spondylocarpotarsal synostosis syndrome (with a posterior midline unsegmented bar).
Spondylocarpotarsal synostosis syndrome (SSS) is characterised by malsegmentation of the thoracic spine and carpal/tarsal fusions. A unilateral or bilateral unsegmented bar may be present in the thoracic spine. Presenting clinical signs are congenital scoliosis early in life, and shortening of the trunk with scoliosis and/or lordosis in older children. We report a 13-year-old girl with SSS and a midline unsegmented bar running along the spinal processes of T3 to L2 and extending into the posterior vertebral elements.
Abnormalities, Multiple↗
Complex bilateral polysyndactyly featuring a triplet of delta phalanges in a syndactylised digit.
The delta phalanx is a rare congenital skeletal anomaly. An abnormal C-shaped epiphysis is usually responsible for a progressive angular digital deformity observed either in hands or feet. Solitary delta phalanges are usually described. We report a case of bilateral congenital hand malformations featuring a triplet of delta phalanges affecting a single digit on one hand, together with a concealed central polydactyly on the other.
Child↗
Congenital balloon digits in two neonates caused by constriction rings.
Balloon digits were found in two neonates with congenital constriction ring syndrome. The affected digits were the right long finger and right great toe. They were surgically treated at the age of 10 and 9 days, respectively. Morphologic improvement was dramatic after surgery. In cases with extensive enlargement, severe cyanosis, redness, and no subsidence of edema within several days after birth, early operative treatment may be necessary to maintain digit viability and prevent autoamputation due to circulatory embarrassment. It can also be helpful to prevent fibrosis of the subcutaneous tissue. Pathologic examination revealed marked proliferation of fibrous tissue and lymphatic vessels.
Constriction, Pathologic↗
[Imaging in the early diagnosis of changes in the hand of patients suffering from rheumatoid arthritis. Is ultrasound a true alternative for low-field magnetic resonance scanning, 3-phase bone scintigraphy and conventional x-rays?].
PURPOSE: Besides the use of conventional x-rays in the diagnostic work-up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The aim of this study was to compare the diagnostic value of ultrasound of the hands with proven methods such as conventional x-rays, low-field MRI and 3P-Sz. METHODS: A total of 30 patients were studied using a 1 day protocol with ultrasound, 3P-Sz, MRI and x-ray of the hands. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA typical and non-RA typical changes. All methods were compared to the summarized findings interpreted by a rheumatologist after 2 years. RESULTS: Of the 30 patients, 19 presented with clinical symptoms of initial changes due to rheumatoid arthritis. Ultrasound revealed 14/19 patients with the correct diagnosis. Conventional x-rays indicated 11/19 patients, while 3P-Sz (100%) and low-field MRI (95%) showed high sensitivity. It was possible to differentiate between inflammation and inconspicuous findings. CONCLUSIONS: An experienced examiner can use ultrasound effectively for the initial diagnosis of RA. Based on its low cost, ultrasound is a valid alternative to conventional x-rays.
Adult↗
Acrorenal syndrome associated with visual defect.
The clinical biochemical, radiological, and histological data of a 5-year-old boy with severe limb deformities and renal failure due to oligomeganephronia and renal hypoplasia are reported. This patient represents another example of acrorenal syndrome. This boy has a severe visual defect due to pigmentory retinopathy, which has not been reported previously.
Child, Preschool↗
The effect of hand osteoarthritis on grip and pinch strength and hand function in postmenopausal women.
The aim of the study was to investigate the effect of osteoarthritis on hand function in postmenopausal women. One hundred patients with hand OA and 70 healthy volunteers as controls were evaluated. Grip and pinch strength measurements and Dreiser's functional index were used for hand function. Pain was assessed by a visual analog scale, and tenderness was assessed by palpation and scored, depending on the severity of tenderness, as 0, 1 or 2. Heberden's and Bouchard's nodules and joint involvement were also recorded. The number of patients with only distal interphalangeal joint involvement was 50 (50%), those with distal interphalangeal joint plus proximal interphalangeal joint involvement was 49 (49%), and those with carpometacarpal joint involvement numbered 18 (18%). The incidence of Heberden's and Bouchard's nodules was 85% and 36%, respectively. Eighty-six (86%) patients were suffering from pain and 57 were found to have tenderness. Grip and pinch strength was significantly lower (p<0.05) and Dreiser's functional index score was significantly higher (p<0.001) in the study group (particularly in grade 4 OA). Grip strength was lower in hand OA patients with distal interphalangeal joint plus proximal interphalangeal joint involvement than in those with only distal interphalangeal joint and carpometacarpal joint involvement. Pinch strength was also lower in patients with distal interphalangeal joint plus proximal interphalangeal joint plus carpometacarpal joint involvement. The patients with Heberden's and Bouchard's nodules had lower grip and pinch strength than controls. Also, pain and tenderness had significant (p<0.05) effects on hand function. Dreiser's total score ranged from 0 to 10 in 80 (80%) patients and from 11 to 20 in 20 patients. In conclusion, hand osteoarthritis contributes to hand dysfunction, mainly related to the severity of osteoarthritis, pain, joint involvement and the presence of nodules.
Aged↗
Increased tear evaporation in a patient with ectrodactyly-ectodermal dysplasia-clefting syndrome.
PURPOSE: To describe the tear function and ocular surface disorders in a patient with ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome. METHODS: Routine ophthalmic examinations were performed, including slit-lamp biomicroscopy, anterior segment photography including transillumination photos of the lids, Schirmer tests I and II, tear film break-up time (BUT) assessment, corneal fluorescein staining, DR-1 tear film lipid layer interferometry, and tear evaporation rate measurements. RESULTS: Slit-lamp examination revealed conjunctival hyperemia, superficial punctate keratopathy, and corneal leucoma with neovascularization. Although the Schirmer test values were within normal limits, the BUT value was 0 s in both eyes. Transillumination of the lids showed the absence of meibomian glandular structures. DR-1 tear film lipid layer interferometry results were dry eye grade 5 with an irregular tear film, areas of corneal surface exposure, and several dry spots. The tear evaporation rate was elevated and was measured as 6.98 x 10(-7) g/cm2 per second (normal, 4.1 +/- 1.4 x 10(-7) g/cm2 per second). CONCLUSION: The ocular surface disorder and shortened BUT in EEC syndrome were attributed to the absence of meibomian glands, leading to lipid layer deficiency in the tear film with a concomitant increase in tear evaporation.
Adolescent↗
Juvenile rheumatoid arthritis persisting inot adulthood.
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Adolescent↗
Free groin skin flaps.
The operative technique of free groin flap transfer is described and some typical results presented. The overall complete success rate in 47 cases was 80 per cent, but complete necrosis only occurred in II per cent of the transferred flaps.
Adult↗
Focusable Doppler ultrasound in mapping dorsal hand flaps.
The dorsal arterial anatomy of 50 normal hands was mapped using high frequency pulsed wave Doppler ultrasound. The findings correlated with previous anatomical studies regarding the variability in the incidence of the arteries. Eight clinical cases were studied preoperatively, seven of whom underwent surgery involving local flaps. Intraoperatively the presence of the mapped vessels was confirmed in each case. This investigation defines the role of high frequency pulsed wave Doppler ultrasound in the mapping of dorsal hand flaps.
Adult↗
Experience in the surgical management of the hand in dystrophic epidermolysis bullosa.
Between 1981 and 1990, 45 patients (80 hands) underwent 122 hand operations, involving extensive release of contractures and pseudosyndactyly, with split skin grafting of secondary defects. Other procedures included the use of Kirschner wires, tendon release and arthroplasty. A postoperative programme of long term night splintage was employed. Finger extension was significantly improved for up to 5 years postoperatively, with a mean extension deficit preoperatively of 139 degrees, at 1 year postoperatively 60 degrees (p < 0.0001) and 4 years 84 degrees (p < 0.05). Preoperatively, pseudosyndactyly was present in 64.3% of web spaces, in comparison to 13.3% at 1 year, 37% at 4 years (p < 0.01) and 66.6% at 5 years (N.S.) postoperatively. Adduction contracture of the thumb was significantly improved for 2 years postoperatively. Functional assessment of 18 hands showed significant improvement postoperatively.
Adolescent↗
Aarskog syndrome. A case report.
A rare Aarskog syndrome is reported in a 12-year-old boy. The patient had a triad of characteristic symptoms consisting of short stature, genital anomaly, and unusual facies. Both jaws were hypoplastic with presence of crowded permanent teeth and over-retained deciduous teeth. Radiographic examination of teeth showed taurodontism, which has not been reported previously.
Abnormalities, Multiple↗
Flexible implant resection arthroplasty.
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Arthroplasty↗