The Relationship Between Structural Analysis of the Hand and Clinical Characteristics in Psoriatic Arthritis

Background:Up to now, there is only limited information available on a possible relationship between clinical characteristics and the mineralization of metacarpal bones and finger joint space distance (JSD) in patients with psoriasis arthritis (PsA). Computerized digital imaging techniques like digital X-ray radiogrammetry (DXR) and computer-aided joint space analysis (CAJSA) have significantly improved the structural analysis of hand radiographs and facilitate the recognition of radiographic damage. The objective of this study was to evaluate clinical features which potentially influence periarticular mineralization of the metacarpal bones and finger JSD in PsA-patients. Methods:201 patients with PsA underwent computerized measurements of the metacarpal bone mineral density (BMD) with DXR and JSD of all finger joints by CAJSA. DXR-BMD and JSD were compared with clinical features such as age and sex, disease duration, C-reactive protein (CRP) as well as treatment with prednisone and disease-modifying antirheumatic drugs (DMARDs).Results:A longer disease duration and an elevated CRP value were associated with a significant reduction of DXR-BMD, whereas JSD-parameters were not affected by both parameters. DXR-BMD was significantly reduced in the prednisone group (-6.6%), but prednisone showed no impact on finger JSD. Patients under the treatment with bDMARDs presented significant lower DXR-BMD (-9.1%), JSDMCP (-16.8%), and JSDPIP (-12.4%) values. Conclusion:Metacarpal BMD was influenced by inflammatory activity, prednisone use, and DMARDs. In contrast, finger JSD showed only a change compared to baseline therapy. Therefore, metacarpal BMD as well as finger JSD represent radiographic destruction under different aspects.

Length of metacarpal and metatarsal bones in five Iranian sheep breeds and their associations with ungula measurements

Background This study aimed to measure the length of metacarpal and metatarsal bones in five Iranian sheep breeds and to correlate the length of the bones with ungula measurements. Thoracic and pelvic limbs of 2-year-old, previously untrimmed, pastured Afshari, Moghani, Kurdi, Makoui, and Lori–Bakhtiari ewes, (n = 20 ewes per breed) were collected after slaughter. The following lengths were recorded in the metacarpal and metatarsal bones: from the margo proximalis lateralis to the lateral (L1) and medial (D1) cartilago physialis; from the margo proximalis lateralis to the margo abaxialis of the lateral (L2) and medial (D2) caput; from the cartilago physialis lateralis to the margo abaxialis of the lateral caput (X1); from the cartilago physialis medialis to the margo distalis of the caput ridge (X2) and from the margo axialis of cartilago physialis to the margo axialis of the lateral caput (X3). Additionally, measurements of the ungula including pars dorsalis length, pars mobilis lateralis and medialis height, pars dorsalis height to the ground and to the solea cornea, thickness of the solea in the pars dorsalis, pars mobilis lateralis and medialis, solea cornea length and angulus dorsalis were recorded in the medial and lateral digits of the thoracic and pelvic limbs. Data on length of the metatarsal and metacarpal bones were analysed using mixed model equations while Pearson correlations were calculated between metacarpal and metatarsal bones and ungula measurements. Results Lori- Bakhtiari and Moghani ewes had greater L1, L2, and D1 and D2 while X1, X2 and X3 was greater in Kurdi ewes (P < 0.05). Measurements such as L1, L2, D1 and D2 were greater in the metatarsal than in metacarpal bones (P < 0.05) and the opposite was observed for X1, X2 and X3 (P < 0.05). No asymmetry was observed between the lateral and medial measurements (P > 0.05). Low to moderate correlations were observed between bone and ungula measurements (P < 0.05). Conclusion Under the conditions of this study, differences in metacarpal and metatarsal bone measurements were observed between breeds but no asymmetry was observed between lateral and medial bones. Results indicate an association between metacarpal and metatarsal bones ungula measurements. This could provide baseline information for the development and/or improvement of current ungula health protocols in the studied sheep breeds.

515 Late-Breaking: Effects of Dietary Phytase with or without Multi-carbohydrase Supplementation on Growth Performance, Nutrient Digestibility, and Bone Traits in Nursery Pigs

The aim was to determine the effects of supplementing increasing doses of phytase (PHY) alone or in combination with multi-carbohydrase (MC) blend to a P-deficient diet for nursery pigs on growth performance, nutrient digestibility, and metacarpal bone characteristics. A total of 192 weaned pigs (7.7 ± 0.05 kg BW) were allotted to 1 of 8 dietary treatments each with 8 replicates in a randomised complete block design based on initial body weight. Diets consisted of a P-deficient negative control (NC), NC + 250 FTU/kg (TRT1), NC + 500 FTU/kg (TRT2), NC + 1,000 FTU/kg (TRT3), NC + 0.2g/kg MC (TRT4), TRT4 + 250 FTU/kg (TRT5), TRT4 + 500 FTU/kg (TRT6), and TRT4 + 1,000 FTU/kg (TRT7). Fecal samples (d 18, 19, and 20) and metacarpal bones (d21) were collected to determine apparent total tract digestibility (ATTD) of energy and nutrients and bone mineralization, respectively. Data were analyzed using the MIXED procedure of SAS with orthogonal polynomial contrast statements with a pen as an experimental unit for growth performance and digestibility and 1 pig per pen for bone traits. During week 2, MC supplementation tended to increase (P = 0.05) body weight whereas by week 3, increasing doses of PHY linearly (P &lt; 0.05) increased average daily gain (ADG). Overall, PHY supplementation had a quadratic effect (P &lt; 0.05) increasing ADG. However, there was an interaction (P &lt; 0.05) whereby PHY and MC in combination acted synergistically to increase percentage of ash and P ATTD. Phytase had linear (P &lt; 0.05) and quadratic (P &lt; 0.05) by increasing fat-free dry weight, ash content, and P in metacarpal bone. In conclusion, increasing levels of PHY quadratically improved growth performance, nutrient digestibility, and bone traits of pigs fed a P-deficient diet.

Open Reduction and Internal Fixation Using Plate and Screws Versus Percutaneous Kirschner Wires Fixation for Second and Third Metacarpal Bones Fractures: A Meta-analysis

Background Metacarpal fractures are among the most common fractures of the skeletal system and account for 36 % of hand and wrist fractures. Aim of the Work To determine the functional outcome and postoperative complications for both these surgical techniques in the treatment of second and third metacarpal bones fractures. Patients and Methods The systematic review was restricted to clinical studies of both these surgical techniques in the treatment of closed second and third metacarpal fractures. We reviewed studies that include management of metacarpal fractures with open reduction and internal fixation using plate and screws versus percutaneous crossed Kirschner wires fixation. Results No specification was made about the type of fracture, other than shaft fractures located in the second and the third metacarpal. All fractures were operated because of instability, angulations’ or rotational deformity. No comparison can therefore be made between fracture type (i.e. spiral, oblique) and functional results. As all studies reported identical indication for surgical fixation a comparison between type of fixation and functional result can be made. Conclusion Based on the reported results there is no evidence to suggest one fixation technique over another. The reported complications however for ORIF and K-wire fixation in the treatment of metacarpal fractures are unmistakably different for the two types of fixation.

Feline Skeletal Reference Guide: A Cadaveric Radiographic Measurement on Lower Limb Extremities

Objective The aim of this study was to create a feline reference database for the length, width and slenderness (length to width ratio) of metacarpal and metatarsal bones, radius and tibia. Study Design Radiographs of the radius, tibia, metacarpus and metatarsus were performed in domestic short hair cat cadavers (n = 40). Length and width of the aforementioned bones were measured in mature domestic shorthair cats and bone slenderness (length/width) and index ratios calculated. Results A significant skeletal sex dimorphism exists in cats, with bones of the metacarpus, metatarsus, radius and tibia generally longer and wider in male cats compared with female cats, with differences frequently significant. The most significant difference was identified for the width of Mc5 (p = 0.0008) and the length and width of Mt5 (p = 0.0005). Index ratios for length and width of radius to metacarpal bones, and tibia to metatarsal bones, were not significantly different between male and female cats, except for Mc5. The index ratio for Mc5 was significantly higher in male cats (p = 0.002). Conclusion The present study provides insights into the normal length and width of distal forelimb and hind limb bones as well as bone index ratios in mature domestic shorthair cats. Using this information, it is now possible to quantitatively assess the relationship between these bones in domestic cats using radiography. This will assist not only with the diagnosis and categorization of skeletal abnormalities but can also guide surgical interventions of metacarpal and metatarsal bone fractures.

Mechanical Evaluation of Two Hybrid Locking Plate Designs for Canine Pancarpal Arthrodesis

Hybrid locking pancarpal arthrodesis plates were designed with either a round (RH) or an oval (OH) radiocarpal hole, the latter allowing varied screw positioning. Due to concerns about potential decreased structural properties of the OH design, our aim was to compare the mechanical behavior of the contrasting plates using combined finite element analysis (FEA) and mechanical testing. Pancarpal arthrodesis plates with RH or OH design were assigned to three fixation techniques ( n = 6 ), prebent at 20°, and fixed to canine forelimb models with simulated radius and radiocarpal and 3rd metacarpal bones. OH plates were instrumented with a radiocarpal screw inserted either most proximal (OH-P) or most distal (OH-D). Specimens were axially loaded to 300 N over 10 ramped cycles at 0.5 Hz. Plate strains were measured with strain gauges placed at areas of highest deformations as predicted by FEA under identical loading conditions. FEA predicted the highest strains (μm/m) adjacent to the radiocarpal hole (2,500 [RH], 2,900 [OH-P/OH-D]) and plate bending point (2,250 [RH], 1,900 [OH-P/OH-D]). Experimentally, peak radiocarpal hole strains were not influenced by the OH screw position ( 3,329 ± 443 [OH-P], 3,222 ± 467 [OH-D]; P = 0.550 ) but were significantly higher compared to the RH design ( 2,123 ± 154 ; P < 0.001 ). Peak strains at the bending point were significantly lower for OH-P ( 1,792 ± 174 ) and OH-D ( 1,806 ± 194 ) versus RH configurations ( 2,158 ± 114 ) ( P ≤ 0.006 ). OH plates demonstrated highest peak strains next to the radiocarpal hole and were associated with more heterogenous plate strain distribution. Structural weakening associated with radiocarpal OH plate design could result in decreased fixation strength and increased risk of plate fatigue failure.

The Effect of Reducing the Bone to Cast Distance in an Equine Transfixation Pin Cast: An Ex Vivo Biomechanical Study

Objective The aim of this study was to evaluate the effect of reducing the bone to cast distance on the resistance of the pin to cyclic loading in equine transfixation pin casts. Study Design Eleven pairs of cadaveric equine third metacarpal bones were prepared and one 6.3/8.0 mm transfixation pin was placed in standard fashion 10 mm proximal to the distal physeal scar into each bone. One metacarpus of each pair was tested with a distance of 10 mm (10 mm group) and the contralateral metacarpus with a distance of 20 mm (20 mm group) between the outer cortex of the bone and the fixation of the pin. Eight pairs were tested using a simplified test set-up in which the pins were fastened at both ends to polyoxymethylene-copolymer sleeves. The pins of the remaining three pairs of bones were incorporated into a fibreglass cast. All specimens were tested under cyclic loading until failure of the pin in axial compression. Results All pins failed uni- or bilaterally at clinically relevant load levels. Pins of the 10 mm group endured significantly (p < 0.05) higher load levels and total number of cycles until failure compared with the pins of the 20 mm group. Conclusion The distance between the bone surface and the cast at the location of pin insertion has a significant effect on resistance of the pins to cyclic loading. Therefore, the amount of padding applied underneath an equine transfixation pin cast can have an influence on the overall stability and durability of the construct.

Upper Limb Pathology in Children with Mucopolysaccharidoses

Background. Despite the success in the treatment of children with mucopolysaccharidoses (MPS) as a result of the widespread of enzyme replacement therapy and hematopoietic stem cells transplantation, orthopedic manifestations continue to be a significant problem, while the pathology of the upper limbs in children with MPS is not sufficiently represented in the literature. The aim of this studywas to analyze orthopedic and neurological manifestations in the upper extremities of children with mucopolysaccharidosis based on a sequential case series. Materials and Methods. We carried out a comprehensive analysis of clinical and radiological involvement of the upper extremities in 49 patients with MPS. Results. The most common complaints reated to the upper extremities were difficulties in the daily activities (dressing, self-care, playing), impairment of the fine motor skills, and muscle weakness. The most frequent clinical manifestations related to the upper extremities were limited active shoulder abduction, impaired hand grip, flexion contractures of the elbow joint, ulnar deviation of the hand. All patients with MPS types I, II, and VI had limited active and passive extension and flexion of the metacarpophalangeal and interphalangeal joints. In patients with MPS IV, hypermobility of the hand joints prevailed. We noticed minimal presence of typical clinical manifestations related to compression of the median nerve secific for carpal tunnel syndrome. The majority of patients showed a decrease in tendon and periosteal reflexes. The most pronounced decrease in muscle strength was observed in to extensors (elbow, fingers) and shoulder abductors, which may contribute to the predominant formation of a flexion pattern of contractures. On radiographs of the hand, the “melting sugar” symptom and shortening of the metacarpal bones were observed in most patients. Conclusion.Clinical and radiological manifestations related to the upper extremities take place in all types of the mPS, and lead to functional disorders that complicate daily life and self-care. Upper limb pathology in children with MPS requires earlier detection and more active treatment after comprehensive risk assessment.

Giant Intraosseous Cyst-Like Lesions of the Metacarpal Bones in Rheumatoid Arthritis

The purpose of this study was to illustrate the clinical and imaging properties of giant intraosseous cyst-like lesions (GICLs) of the metacarpal bones extending beyond the central diaphysis in rheumatoid arthritis (RA) patients on magnetic resonance (MR) images. A keyword search was conducted to extract GICLs of the metacarpal bones out of MR reports in RA patients. There were nine GICLs extending from the subchondral bone region beyond the central diaphysis of the metacarpal bones on MR images in eight subjects with RA (seven females, one male). The age range was from 60 to 87 years with a median age of 65.5 years. The average disease duration was 13.1 years. As for the disease activity, one was low, six were moderate and one was high. None of the nine lesions were visible on radiography. The Steinbrocker stage distribution was as follows: I (n = 3), II (n = 2), and III (n = 3). Intraosseous cyst-like lesion of the metacarpal bones on MR images is a relatively rare manifestation in patients with long-standing RA. Although the lesion seems to be derived from subcortical bone break, it is not necessarily erosive in nature.