Ulnar Superficialis Slip Resection versus Radial Superficialis Slip Resection: A Biomechanical Pilot Study

Background: There are numerous clinical scenarios during which the surgeon contemplates whether the radial or ulnar slip of the flexor digitorum superficialis (FDS) should be sacrificed. To date no study has assessed the point of failure of each one of the FDS slips in each digit, aiding the avid surgeon in deciding which slip to sacrifice. Methods: A total of 41 digits were assessed, each digit was dissected, and a specimen containing the denuded bone of the middle phalanx with the attachments of the ulnar and radial FDS slips was obtained. An Instron 4502 device was utilized to biomechanically assess the point of failure of each slip of each digit. Results: There was no statistical difference between ulnar and radial slip point of failure when compared across all digits and subjects. There was no statistical difference between male and female subject’s specimens. The point of failure was higher in the ulnar slips of the second and third digits, whereas the point of failure was higher in the radial slips of the fourth and fifth digits. Conclusions: Sacrifice of a FDS slip may cause loss of grip strength. In several clinical scenarios one may be faced with the dilemma which FDS slip to sacrifice. Our findings show this is not an arbitrary choice. Hand surgeons should keep our findings in mind when deciding which slip to sacrifice, in effort to preserve function and strength in the injured hand.

Middle east pain syndrome is a pollution-induced new disease mimicking rheumatoid arthritis

Musculoskeletal pains are sometimes misdiagnosed in some diseases, like rheumatoid and psoriatic arthritis, erosive OA, etc. Secondary hyperparathyroidism was not considered a differential diagnosis for RA, despite the fact that it can cause arthralgia or arthritis. Also, fibromyalgia is a psychosomatic condition marked by widespread pain and tenderness. This study included 400 patients attended certain outpatient clinics of Rheumatology in Egypt and Saudi Arabia, who were not fulfilling criteria for RA diagnosis. Criteria for classification of fibromyalgia syndrome were applied to all patients. We did lab tests and radiological imaging modalities for diagnosis or exclusion of suspected diseases were applied. All patients were fulfilling both old and new criteria of fibromyalgia syndrome, and not fulfilling any RA criteria, and had vitamin D3 deficiency or insufficiency. 75% of patients had abnormally high levels of PTH, without parathyroid gland pathology. Radiology showed subperiosteal and subchondral resorption of mainly thumbs, subchondral osteopenia of proximal and middle phalanges, mild subperiosteal resorption along the radial aspect of the middle phalanx and mild tuft erosions, besides changes in the carpus closely resembling those of rheumatoid arthritis, of ulnar styloid resorption, radiocarpal and scapho-trapezoid joint arthritis. Of special interest, the presence of tuft spur-like excrescences.

Analysis of Hot-Cold Confusion on Fingers

The thermosensory system may misidentify a temperature stimulus with different thermal properties. The mechanism of this hot-cold confusion has not been clarified; hence, it has not yet been applied. In this study, we created a wearable temperature presentation device that is closer to the application and analyzed the tendency and mechanism of temperature confusion by analyzing the hot-cold confusion of temperature sensation in the fingers, which are most frequently in contact with objects. Two experiments were performed. In the first experiment, we presented stimuli on the tips of three fingers (first, second, and third fingers). In the second experiment, we presented stimuli at the center of the distal phalanx, middle phalanx, and proximal phalanx of the first finger. The experimental results indicated the occurrence of hot-cold confusion. Domination, in which the center is dominated by both ends, and a mutual effect, in which the center interacts with both ends, were observed.

Broken Kirschner Wire in Distal Interphalangeal Joint Fixation: A Case Report

Kirschner wire (K-wire) has been widely used for treatment of fracture for its cost-effectiveness and reliability. This case presents the K-wire breakage in distal interphalangeal joint (DIPJ) fixation. A 55-year-old male patient was injured by a knife and showed rupture of extensor tendon at 1/2 of middle phalanx. A 0.9-mm K-wire was implemented for DIPJ extension, and tenorrhaphy was done. After 6 weeks, we detected breakage of K-wire in the follow-up X-ray. The broken K-wire in the distal phalanx was removed. We removed the remaining K-wire through an incision on volar side of middle phalanx under C-arm after 2 weeks for the patient’s personal reasons. Breakage during postoperative K-wire maintenance is exceedingly rare. This patient is presumed to have ruptured because he continued using his finger. Therefore, while K-wire is present, continued use of finger without protection may cause breakage, so protective measures such as splint are required.

Free Vascularized Joint Transfer from Toes for Finger Reconstruction in a 2-Year-Old Child with Good Functional Recovery

A 2-year-old male child sustained injury to middle and ring fingers of the right hand following a road traffic accident. He had mutilated fingers with loss of middle phalanx along with proximal interphalangeal (PIP) joint, distal interphalangeal joint of middle finger, and loss of part of middle phalanx and PIP joint of the ring finger. There was dorsal tissue loss of both the fingers. With staged reconstructive strategy, we could salvage the fingers. In the initial part, the soft tissue reconstruction was done using pedicled groin flap. In the later stage, free PIP joint transfer from the second toes of both feet was used to reconstruct the bone and PIP joint of the ring and middle finger. A year following the joint transfer, the child had good functional outcome.