Search Results (39)

Introduction: Finger injuries are common in pediatric patients and typically heal well with conservative management. However, rare fracture patterns involving significant displacement and physeal injury, such as the one described in this case, require specialized surgical intervention to ensure proper healing and prevent long-term complications. Case Presentation: A 12-year-old left-hand-dominant female presented with pain, swelling, and deformity at the distal interphalangeal (DIP) joint following hyperextension of the left fifth digit. Initial radiographs revealed a volar displaced intra-articular fracture with physis involvement, confirmed by computed tomography (CT) imaging. Conservative management with closed reduction and splinting failed to achieve adequate alignment. Surgical intervention was performed via a dorsal approach, utilizing ORIF with K-wire fixation to restore joint congruity and ensure anatomic alignment. Outcomes: Postoperative follow-up demonstrated satisfactory healing, maintained reduction, and resolution of pain with no complications. The patient regained functional use of the digit with minimal stiffness, and the growth plate remained uninvolved during the recovery period. Discussion: This case underscores the importance of advanced imaging, early referral, and tailored surgical intervention for rare mallet fractures involving volar displacement and physeal injury. ORIF provided reliable stabilization and optimal outcomes in this complex case. Conclusions: Volar displaced Salter–Harris III fractures of the DIP joint are rare and challenging injuries in pediatric patients. This case highlights the role of ORIF in achieving successful outcomes and emphasizes the importance of precise reduction and stabilization to prevent long-term complications. Full article

Background: Syndactyly, the congenital fusion of digits, compromises hand function and esthetics. Although surgical separation is the standard treatment, the optimal timing of the intervention remains controversial. Methods: We prospectively analyzed 20 pediatric patients (86 operated fingers) undergoing syndactyly repair, comparing early (≤24 months) versus delayed (>24 months) surgery. Outcome measures included range of motion (ROM) at the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints; complications (synostosis, nail deformities, finger length disparity, webbing); and patient-reported outcomes assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and overall esthetic satisfaction scores. Results: The median age at surgery was 31 months (IQR25/75: 24.75–36.5), with a median follow-up of 72 months (IQR25/75: 42.0–86.25). Notably, digits III (28.24%) and IV (29.41%) were predominantly affected. Delayed surgery resulted in significantly improved MP ROM (90.98° ± 8.44° vs. 73.13° ± 22.37°, p = 0.004) and DIP ROM (76.28° ± 22.24° vs. 67.19° ± 22.78°, p = 0.028), with a non-significant trend toward better PIP ROM (93.00° ± 25.18° vs. 77.37° ± 30.29°, p = 0.075). Furthermore, the incidence of synostosis was markedly reduced in the delayed surgery group (6.0% vs. 38.9%, p = 0.001). Despite superior joint function associated with delayed intervention, early surgery patients reported higher satisfaction with cosmetic results (3.00 vs. 2.80, p = 0.028), while the DASH scores remained comparably low between groups (0.00 vs. 0.24, p = 0.141). Finger length disparities and webbing were minimal. Conclusions: Our study challenges the conventional advocacy for early syndactyly repair, by demonstrating that delaying surgery beyond 24 months significantly enhances joint mobility and reduces the synostosis rate. However, the higher satisfaction observed as a result of early intervention suggests that surgical timing should be individualized for affected fingers, joints, and severities to balance the functional and cosmetic outcomes. Further studies are needed to define the optimal surgical timing and techniques for pediatric syndactyly. Full article

Therapeutic shoeing for horses is used to affect the palmar angle (PA) of the distal phalanx. These changes may influence the strain on the distal interphalangeal joint collateral ligaments (DIJCLs). This cadaveric study aimed to assess DIJCL strain under varying loads and PA adjustments. Using 26 cadaver forelimbs, eight optical markers were placed on one DIJCL for strain measurement under five different loads (1000–5000 newtons) at a neutral PA, followed by PA increases of 2°, 4°, and 6° and decreases of −2° and −4°. The results indicate that increases in PA corresponded to significantly higher strain in the distal and mid distal portions, while 2° and 4° decreases in PA significantly reduced the strain in the proximal regions of the DIJCLs. Limitations include potential discrepancies between a cadaver and live biomechanics. This study concludes that increased PA increases distal DIJCL strain, while decreased PA decreases proximal strain. Further research is recommended to evaluate the practical implications of these findings in DIJCL injuries in horses. Full article

Background/Objectives: An Extensor Pollicis Longus (EPL) subcutaneous rupture is a substantial complication in post-traumatic or degenerative wrist and tendinous lesions. The diagnosis is essentially dictated by a clinical evaluation; in fact, it is characterized by the inability to extend the thumb interphalangeal joint and to retropose the thumb while the hand is resting on a surface. The tendinous transposition using the Extensor Indicis Proprius (EIP) as a donor tendon is a well-known surgical technique performed to restore functional activity to the thumb, and it is preferred for the closer cerebellar network with the thumb itself. However, there is a dearth of clinical results and scientific evidence in the literature. The aim of this study is to evaluate the return-to-work eligibility after an inveterate EPL subcutaneous rupture repaired with a transposition of the EIP. Methods: Patients who reported a subcutaneous rupture of the EPL due to rheumatic diseases or who had undergone previous hand or wrist surgery were excluded; however, all patients tested positive for traumatic wrist hypertension. The surgical technique involves three small incisions to achieve tenorrhaphy of the EIP at the distal head of the EPL. Dynamic tests are carried out intraoperatively to verify the tightness and sufficient rigidity of the suture. The objective evaluation involves the range of motion, pinch strength, and power extension of the thumb and the index finger. Patient-reported outcome measures for pain and patient satisfaction include the Numeric Pain Rating Scale and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Results: A total of 12 patients were eligible (7 W, 5 M, mean age 56.3 years) and were followed for at least one year. There were no surgery-related complications. After the cast was removed 3 weeks after surgery, patients could extend their thumbs, put them back, and use their index fingers. An immediate improvement in objective and subjective assessments was reported. At 10 weeks, nine patients (75%) returned to full work with no pain and without the aid of rehabilitation; two patients (17%) returned to full work with no symptoms 2 weeks later; and only one patient (8%) with a neurological disease required physical therapy, achieving pain control and restoration of full mobility approximately six months after surgery. Conclusions: This surgical technique seems to address satisfactory results in terms of skill recovery and rapid return to work. A tailored rehabilitation program should be implemented for selected patients with neurological conditions that may prolong the adaptation process of the transposed tendon, the coordination, and the independent function of the thumb and index finger. Full article

Hand paralysis, caused by conditions such as spinal cord injuries, strokes, and arthritis, significantly hinders daily activities. Wearable exo-gloves and telerehabilitation offer effective hand training solutions to aid the recovery process. This study presents the development of lightweight wearable exo-gloves designed for finger telerehabilitation. The prototype uses NiTi shape memory alloy (SMA) actuators to control five fingers. Specialized end effectors target the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, mimicking human finger tendon actions. A variable structure controller, managed through a web-based Human–Machine Interface (HMI), allows remote adjustments. Thermal behavior, dynamics, and overall performance were modeled in MATLAB Simulink, with experimental validation confirming the model’s efficacy. The phase transformation characteristics of NiTi shape memory wire were studied using the Souza–Auricchio model within COMSOL Multiphysics 6.2 software. Comparing the simulation to trial data showed an average error of 2.76°. The range of motion for the MCP, PIP, and DIP joints was 21°, 65°, and 60.3°, respectively. Additionally, a minimum torque of 0.2 Nm at each finger joint was observed, which is sufficient to overcome resistance and meet the torque requirements. Results demonstrate that integrating SMA actuators with telerehabilitation addresses the need for compact and efficient wearable devices, potentially improving patient outcomes through remote therapy. Full article

After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the “abbreviato” technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford’s and Levante’s criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante’s criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante’s criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures. Full article

Digital mucous cysts (DMCs) are common soft tissue tumors affecting interphalangeal joints. Various treatment options exist, with surgical excision being the standard. Ultrasound-guided cortisone (CC) injection into the distal interphalangeal (DIP) joint has been proposed as a therapeutic alternative. This study aims to assess the technical success and clinical efficacy of US-IPI in terms of swelling resolution and pain control. Fifty-two patients with DMCs underwent CCs DIP joint ultrasound-guided infiltration. Eighty-three percent of patients exhibited a positive response to US-IPI, with a significant reduction in NRS pain scores (p < 0.01). Persistent pain in 17% of patients was effectively managed with marked improvement after a secondary infiltration. Joint swelling was reduced in 68% of patients within 1 month, with complete resolution by 3 to 6 months. No recurrence was reported at the 6-month follow-up. Pain assessment using the Numeric Rating Scale and joint swelling evaluation were conducted at follow-ups of 2 weeks, 1, 3, and 6 months. Statistical analysis was performed to compare pre- and post-procedure NRS pain scores. Here, we show that US-IPI of DMCs is an effective therapeutic option that provides immediate pain relief and long-term aesthetic improvement, resulting in an alternative option to surgical excision. Full article

Considering the biomechanical and cognitive aspects involved in tool manipulation, hand size emerges as a critical factor. Males, on average, exhibit greater grip strength attributed to larger hand dimensions. Beyond mere physical factors, cognitive components tied to visuospatial abilities also influence stone tool use. However, the intricate relationship between hand size, grip strength, and ergonomic patterns necessitates further exploration. Here, we study the ergonomic pattern of phalanx flexion during the manipulation of Lower Paleolithic stone tools (choppers and handaxes) to understand the nuanced interplay between hand dimensions and grasping behaviors in Lower Paleolithic stone tool use. The static hand posture during the comfortable grasping of each tool is measured using a motion capture hand glove. Flexions are measured at the metacarpophalangeal joint, the proximal interphalangeal joint and the distal interphalangeal joint of each finger. Our investigation into Lower Paleolithic stone tool manipulation reveals gender-based differences in phalanx flexion, with hand dimensions showing correlation only in pooled samples. However, these associations diminish when analyzing males and females separately. This study suggests a minimal link between hand size and grasping behavior within our sample, hinting at the influence of cognitive, behavioral, and motor factors. Exploring lifestyle and psychometric profiles could provide further insights. In the context of early human technology, our results prompt considerations on the evolution of the hand-tool interaction system, linking our tool-dependent culture to our phylogenetic history. Full article

(1) Introduction: Tendinous mallet finger is a frequent deformity that occurs after an extensor tendon injury during sports or daily life activities. Despite the existence of numerous non-operative and operative techniques to address this deformity, there is a controversy on its optimal management. In this study, we aimed to present a direct tendon suture technique using the distal interphalangeal (DIP) joint open approach for treating tendinous mallet finger injury. (2) Methods: Between 2019 and 2021, 19 patients with closed non-fracture tendinous mallet fingers underwent the direct tendon and paratenon repair technique. After skin incision, we opened the paratenon with lazy S shape incision and found the ruptured proximal and distal tendon ends. We reapproximated the tendons using a simple interrupted suture with Prolene #6/0. After that, we meticulously performed paratenon repair using PDS #6/0 for preventing readherence. Temporary trans-articular Kirschner wire fixation was used for 4 weeks. (3) Results: All patients were followed-up for 3–8 months (mean: 4.8 months). The mean final extension lag was 6.5 degrees, and the overall rate of cases with excellent and good outcomes using Crawford’s criteria was 85%. (4) Conclusions: In conclusion, this surgical approach could be a reliable alternative for the treatment of tendinous mallet finger injuries. Full article

The rehabilitation process after the onset of a stroke primarily deals with assisting in regaining mobility, communication skills, swallowing function, and activities of daily living (ADLs). This entirely depends on the specific regions of the brain that have been affected by the stroke. Patients can learn how to utilize adaptive equipment, regain movement, and reduce muscle spasticity through certain repetitive exercises and therapeutic interventions. These exercises can be performed by wearing soft robotic gloves on the impaired extremity. For post-stroke rehabilitation, we have designed and characterized an interactive hand orthosis with tendon-driven finger actuation mechanisms actuated by servo motors, which consists of a fabric glove and force-sensitive resistors (FSRs) at the tip. The robotic device moves the user’s hand when operated by mobile phone to replicate normal gripping behavior. In this paper, the characterization of finger movements in response to step input commands from a mobile app was carried out for each finger at the proximal interphalangeal (PIP), distal interphalangeal (DIP), and metacarpophalangeal (MCP) joints. In general, servo motor-based hand orthoses are energy-efficient; however, they generate noise during actuation. Here, we quantified the noise generated by servo motor actuation for each finger as well as when a group of fingers is simultaneously activated. To test ADL ability, we evaluated the device’s effectiveness in holding different objects from the Action Research Arm Test (ARAT) kit. Our device, novel hand orthosis actuated by servo motors (NOHAS), was tested on ten healthy human subjects and showed an average of 90% success rate in grasping tasks. Our orthotic hand shows promise for aiding post-stroke subjects recover because of its simplicity of use, lightweight construction, and carefully designed components. Full article

Background. Osteoarthritis of the hand joints in systemic sclerosis (SSc) patients might be an independent manifestation leading to limitation of upper extremity function. There is no publication quantitatively assessing the thickness of articular cartilage within the hand joints of SSc patients by MRI. The purpose of our study was to quantify the condition and thickness of hand joints cartilage with three-dimensional quantitative MRI (3D q-MRI). Methods. The study was conducted in twenty people: ten patients with SSc and ten healthy individuals. All participants were examined with the 3D q-MRI with 3T scanner. The cartilage thickness of proximal (PIP) and distal interphalangeal (DIP) joints as well as metacarpophalangeal joints was measured. Results. There was no significant difference in cartilage thickness between both groups. However, the joint cartilage was thinner in fingers with acro-osteolysis. In PIP joint of the fingers with acro-osteolysis, the mean cartilage thickness was 0.5 mm (p = 0.0043) and 0.4 mm (p = 0.0034) in DIP joints. Conclusions. Quantitative MRI analysis of the joints of the hands of SSc patients does not indicate changes in thickness of the articular cartilage. A significant reduction in the articular cartilage thickness of the fingers with acro-osteolysis indicates the potential of an ischemic basis of articular cartilage destruction in SSc patients. Full article

Introduction: Tendinous and bony mallets are very different injuries that present with extensor lag at the distal interphalangeal joint. This study aimed to evaluate the differences in outcomes between acute bony and tendinous mallet fingers treated conservatively with splints. Materials and Methods: We retrospectively collected data on patients with acute tendinous or bony mallets who received conservative treatment in our occupational therapy clinic. The patients were examined at an outpatient clinic, where data on pain, extension lag, and loss of flexion were recorded. Outcomes were classified according to the criteria described by Crawford. Results: Data were collected from 133 patients (43 with bony and 90 with tendinous mallets). We found that bony mallet patients were predominantly younger (mean, 36 vs. 46 years), and more likely to be female (60% vs. 34%), than tendinous mallet patients. We also found that tendinous mallet injuries predominantly affected the middle and ring fingers, while bony mallet injuries predominantly affected the ring and little fingers. The initial extensor lag was worse in tendinous than in bony mallets (median, 28° vs. 15°). In addition, patients with bony mallets had significantly better outcomes with regard to the extension lag (median 0° vs. 5° p = 0.003) and the Crawford Criteria Assessment (p = 0.004), compared with those with tendinous mallets. Discussion: Mallet injuries, both tendinous and bony, are common. They are often studied together and typically treated in the same manner using extension splints. However, evidence clearly shows that these are different injuries which present in the same manner. This study reinforces these findings and suggests that the outcome of conservative treatment is better for bony than for tendinous mallet fingers. Full article

This study introduces a new wearable fiber-optic sensor glove. The glove utilizes a flexible material, polydimethylsiloxane (PDMS), and a silicone tube to encapsulate fiber Bragg gratings (FBGs). It is employed to enable the self-perception of hand posture, gesture recognition, and the prediction of grasping objects. The investigation employs the Support Vector Machine (SVM) approach for predicting grasping objects. The proposed fiber-optic sensor glove can concurrently monitor the motion of 14 hand joints comprising 5 metacarpophalangeal joints (MCP), 5 proximal interphalangeal joints (PIP), and 4 distal interphalangeal joints (DIP). To expand the measurement range of the sensors, a sinusoidal layout incorporates the FBG array into the glove. The experimental results indicate that the wearable sensing glove can track finger flexion within a range of 0° to 100°, with a modest minimum measurement error (Error) of 0.176° and a minimum standard deviation (SD) of 0.685°. Notably, the glove accurately detects hand gestures in real-time and even forecasts grasping actions. The fiber-optic smart glove technology proposed herein holds promising potential for industrial applications, including object grasping, 3D displays via virtual reality, and human–computer interaction. Full article

Subchondral cystic lesions (SCLs) in equines and their treatments have been mainly studied in the medial femoral condyle of the femur. SCLs in the distal extremities affecting the fetlock or interphalangeal joints are frequent, but treatment or prognosis studies in horses are currently sparse. Our objective was to compare four treatments for SCLs in the distal extremities (intralesional injection of corticosteroids, transcortical drilling, cortical screw placement, and absorbable hydroxyapatite implant placement) and report the racing prognoses for affected thoroughbred yearlings. Data from 113 thoroughbred yearlings treated for SCLs in the distal extremities were collected from 2014 to 2020. Age at surgery, sex, bone affected, radiographic SCL measurements, SCL shape, and type of treatment were recorded. Sale data and racing performance were collected for the operated horses and for 109 maternal siblings that were free of SCLs. An analysis was conducted to assess if SCL size affected racing prognosis and to detect differences in sale value and selected racing parameters between the cases and controls. The outcomes for the different treatments, the different bones affected, and the SCL shape type were also analyzed. There was no difference in the ability to start in a race between the cases and controls (60.2% vs. 69.7%, respectively). The auction value of the treated horses was significantly lower than that of their siblings. The bone affected did not impact any of the racing variables studied, whereas the height of the SCLs negatively affected the number of wins and placed races. The type of treatment for the horses affected by SCLs did not have an impact on sale prices, ability to start a race, race starts, wins, and places, or age at the time of the first start. In conclusion, yearlings diagnosed with an SCL in the distal extremities had lower auction prices and decreased racing performances, with lower numbers of wins correlated with larger SCL heights compared to the siblings. Similar racing performance was found regardless of the treatment received. Full article

Hand Osteoarthritis (HOA) is a frequently occurring musculoskeletal disease that impacts health. Diagnostic criteria often incorporate osteophytes documented through imaging procedures. Radiographic imaging is considered the gold standard; however, more sensitive and safer methods like ultrasound imaging are becoming increasingly important. We conducted a population-based cross-sectional study to examine the prevalence, grade, and pattern of osteophytes using high-resolution ultrasound investigation. Factory workers were recruited on-site for the study. Each participant had 26 finger joints examined using ultrasonography to grade the occurrence of osteophytes on a semi-quantitative scale ranging from 0–3, where higher scores indicate larger osteophytes. A total of 427 participants (mean age 53.5 years, range 20–79 years) were included, resulting in 11,000 joints scored. At least one osteophyte was found in 4546 out of 11,000 (41.3%) joints or in 426 out of 427 (99.8%) participants, but only 5.0% (553) of the joints showed grade 2 or 3 osteophytes. The total osteophyte sum score increased by 0.18 per year as age increased (p < 0.001). The distal interphalangeal joints were the most commonly affected, with 61%, followed by the proximal interphalangeal joints with 48%, carpometacarpal joint 1 with 39%, and metacarpophalangeal joints with 16%. There was no observed impact of gender or workload. In conclusion, ultrasound imaging proves to be a practical screening tool for osteophytes and HOA. Grade 1 osteophytes are often detected in the working population through ultrasound assessments and their incidence increases with age. The occurrence of grade 2 or 3 osteophytes is less frequent and indicates the clinical presence of HOA. Subsequent evaluations are imperative to ascertain the predictive significance of early osteophytes. Full article