Hyperbaric Oxygen Therapy and Prostaglandin usage for Shred Injury in the Fingers: A Case Report

A 53-year-old woman came to the emergency department because her right hand had been stuck in a potato-shredding machine for 30 minutes. The 2nd, 3rd, and 4th fingers were shredded into multiple slices deep into the phalangeal bone, which showed good circulation, and the wounds were cleaned with massive saline irrigation. The slices of each finger were put together to form the finger, which was sutured with nylon, and the circulation of the fingers remained good. Three weeks of gentamicin, cefazolin, and hyperbaric oxygen therapy were used for acute traumatic ischemia since the color change of fingers was observed. Six weeks of prostaglandin was used for circulation recovery. The patient was able to grasp with minimal pain and do flexion and extension, and the wound was completely healed. Radiography showed the bone union process, and the digital infrared thermal imaging test showed relatively good circulation.

Treatment of Phalangeal Joint Stiffness Related to Proximal Phalangeal Bone Fractures: Therapeutic Effects on the Range of Motion and Finger Pain

Purpose: Proximal phalangeal bone fractures with displacement are treated using operative procedures. These fractures can cause stiffness of the interphalangeal or metacarpophalangeal joints, which can be relieved using various operative and nonoperative techniques. This study analyzed the range of motion (ROM) and pain after a combination therapy to treat finger stiffness following proximal phalangeal fractures.Methods: Fifty-two patients who underwent operative procedures for proximal phalangeal fractures and showed finger stiffness from March 2015 to January 2021 were included in this retrospective study. The patients in group 1 (n=24) performed elastic resistance exercises, while those in group 2 (n=28) underwent conventional exercise. ROM and pain score were measured at 5, 8, and 12 weeks postoperatively. Furthermore, a patient with a swan-neck deformity and intractable stiffness was treated using partial translocation of the extensor apparatus, and the postoperative outcome is presented.Results: Group 1 showed a larger ROM and less pain than group 2 at 12 weeks postoperatively (p<0.05). Patients in both groups exhibited notable improvements with regard to ROM and pain during the study period (p<0.05). In addition, the swan-neck deformity accompanying hyperextension of the proximal interphalangeal joint was significantly relieved.Conclusion: Proximal phalangeal bone fractures can lead to stiffness of the interphalangeal and metacarpophalangeal joints. Joint stiffness was relieved using an elastic resistance exercise protocol in the early postoperative period. Intractable stiffness showing a fixed joint angle can be treated with thorough tenolysis and corrective surgery.

Distal phalangeal bone erosions observed by HR-pQCT in patients with psoriatic onycholysis

Objectives PsA prevalence among skin psoriasis is ∼30%. Nail psoriasis, especially onycholysis, is present in &gt;70% of PsA and the risk of developing PsA is more than doubled in patients with nail involvement. We hypothesized that onycholysis may be associated with early bone erosions of the DIP joint without harbouring PsA symptoms. Methods We compared tendon thickness, assessed by US, and bone erosions, assessed by high-resolution peripheral quantitative CT, of the DIP joint in patients with psoriatic onycholysis without PsA (ONY) with those in patients with cutaneous psoriasis only (PSO). We used patients with PsA as reference (PsA group), and healthy age-matched controls (CTRL). Differences between groups were assessed by analysis of variance tests followed by post hoc analysis using the Scheffe method. Results Mean (s.e.m.) age of the 87 participants (61% males) was 45.2 (1.3) years. The mean extensor tendon thickness was significantly larger in ONY than in PSO patients. In the PsA group, 68% of patients exhibited erosions of three different shapes: V-, Omega- and U-shape. Association with erosions was greater in the ONY group than in the PSO group (frequency: 57 vs 14%; P &lt; 0.001; mean number of erosions: 1.10 (0.35) vs 0.03 (0.03); P &lt; 0.001). Conclusion Onycholysis was associated with significant enthesopathy and bone erosions in our cohort. These data support the pathogenic role of enthesopathy in PsA. Onycholysis may be considered as a surrogate marker of severity in psoriasis. Trial registration ClinicalTrails.gov, https://clinicaltrials.gov, NCT02813720

Vocal Folds: An Unusual Hideout for Systemic Sarcoidosis

Sarcoidosis is a chronic inflammatory granulomatous disease of unknown etiology. It can expand to all organs and tissues. Lungs and lymph nodes are the most commonly involved tissues. Laryngeal sarcoidosis is rare, accounting for no more than 1% of patients with systemic sarcoidosis. We herein report the case of a 51-year-old female presenting a two-year history of persistent voice hoarseness with direct laryngoscopy findings of epiglottis swelling and irregular swelled and bruised left vocal fold. Histological examination highlighted the presence of non-caseating granulomas. Further investigations revealed similar histological findings in the nasal cavity as well as lymphocytic alveolitis. It also showed the presence of phalangeal bone lesions of both hands. All these pointed to the diagnosis of sarcoidosis with upper respiratory tract (nasal and laryngeal), lung and bone involvement. The patient was started on 0.5 mg/kg daily of prednisone for 1 month followed by progressive tapering with lasting favorable outcome.

Late-onset osteosarcoma after onychectomy in a cat

Case summary A 12-year-old neutered male onychectomized Ragdoll cat presented for a 3 day history of swelling and hemorrhagic purulent discharge on the first digit of the left manus. Radiographs revealed fragments of the third phalangeal bone (P3) present in the partially amputated digits with swelling adjacent to the P3 fragment on the first digit of the left manus. Thoracic radiographs revealed no evidence of primary or metastatic neoplasia. Surgery was performed to remove all P3 fragments and the associated swelling on the diseased digit. On gross examination of the excised swelling, a mass was present at the cut edge of P3. The bone fragment and associated mass were submitted for histopathological evaluation. Osteosarcoma was diagnosed. Because neoplastic cells extended to the surgical margins, amputation of the left thoracic limb was performed. The cat recovered from surgery, and survival time at the time of writing was 8 months. Relevance and novel information To our knowledge, this is the first reported case of onychectomy-associated osteosarcoma. Trauma from partial P3 amputation during onychectomy is suspected to have played a role in osteosarcoma development in this case. Malignant transformation may be considered a potential complication of onychectomy achieved by partial P3 amputation.

Digital Arteriovenous Fistula Formation Associated with Bone Fracture Induced Blunt Trauma

An arteriovenous fistula formation caused by a blunt trauma is a quite rare complication, especially in the hand. We report an extremely rare case of a traumatic arteriovenous formation in a finger that developed 5 years after the patient received a blunt trauma in conjunction with a phalangeal bone fracture. Successful management was achieved by direct surgical resection of the arteriovenous fistula without any complication.