Dermatoglyphics of the Digits and Inter-digit Areas in Down Syndrome Patients of a Sampled Nigeria Population

This study was carried out to determine the possible differences between the dermatoglyphic characteristics of the digit and inter-digit areas of Down Syndrome (DS) patients and healthy Nigerians. The dermatoglyphic prints of the digit and inter-digit areas were obtained by using the improvise digital method. Parameters evaluated were the digit patterns, inter-digit patterns and single flexion crease of the fifth digit. Comparison of dermal patterns in DS patients and normal ones was done using Chi-square test at a significant level of P = .05. The result of the digit patterns showed that the total mean percentage frequency for arch, radial loop, ulnar loop and whorl were 5.28%, 0.34%, 75.94% and 18.45% in DS patients and 9.55%, 1.11%, 60.11% and 29.22% in normal subjects respectively. The distribution of dermal ridge differ significantly in digits I, II and III of the right hand and digits II and III of the left hand in patients and normal subjects at P = .05 level. Down syndrome patients had more of open fields in all the inter-digit areas except in inter-digit C. The difference in patterns between DS patients and normal subjects was significant in inter-digit C and D of the left hand only. One normal subject had single flexion crease compared to four in Down syndrome patients. The findings of the study could be used as supplementary diagnostic aid for Down syndrome.

TRIGGER THUMB IN CHILDREN

The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagnose this deformity with ultrasound as a potential early diagnostic tool. It is possible to misdiagnose a fracture, dislocation of the thumb or thumb-in-palm deformity. Clinical investigation has improved our understanding of the natural history and its benignancy. Therapeutic treatment depends on parent and physician preference. It can be either conservative, consisting of splint therapy and passive stretching exercises, or surgical, releasing of the A1 pulley that reliably restores thumb interphalangeal joint motion. Although it may take several years for spontaneous resolution, families willing to wait are given an opportunity to avoid hospitalization stress and surgical intervention.

Using the main elbow flexion skin crease as an intraoperative parameter to determine the degree of exorotation needed for humeral derotational osteotomies in upper-type brachial plexus patients

Even though one of the surgical techniques most frequently used to correct external rotation deformity of the shoulder in brachial plexus patients is a humeral derotational osteotomy, few intraoperative parameters has yet been identified to determine the appropriate degree of rotation. We present in this technical note our initial experience using the main elbow flexion skin crease to quantify the correct rotation of the humerus in four young, male patients with upper-type brachial plexus injuries. All patients had a functional elbow and a stable shoulder, but also an external rotation deficit. Via a deltopectoral approach, we used the main elbow flexion crease as an intraoperative surgical parameter to determine the degree of external rotation of the humerus required to achieve a better positioning of the hand in space. After surgery, increased elbow flexion range and enhanced hand-to-face movement was observed, while internal rotation was preserved for performing midline activities. Moreover, all patients exhibited increased active elbow flexion and osteotomy consolidation, with mean elbow flexion increasing from 66.3° to 97.5° pre to postoperatively, and a mean 56.3° of internal rotation correction ultimately achieved. We propose that the main elbow flexion crease is a useful intraoperative parameter to determine the degree of intraoperative external rotation necessary to restore the plane of hand–face movements in upper-type palsies. Level of evidence: IV; case series.

Mild Dermatoglyphic Deviations in Adolescents with Autism Spectrum Disorders and Average Intellectual Abilities as Compared to Typically Developing Boys

Dermatoglyphics, ridge constellations on the hands and feet, are permanently formed by the second trimester of pregnancy. Consequently, they are considered “fossilized” evidence of a specific prenatal period. A high frequency of dermatoglyphic anomalies, or a high rate of dermatoglyphic asymmetry (discordance), is an indication of developmental instability (prenatal disturbances) prior to 24-week gestation. Most dermatoglyphic studies in psychiatry focus on adult schizophrenia. Studies on dermatoglyphic deviances and autism are sparse, include severely disturbed and intellectually retarded patients with autism, and are carried out mainly in non-Western European populations. In this study, finger print patterns, atd-angles, and palmar flexion crease patterns (PFCs) are compared between Western European adolescent teenage males, of average intellect, with Autism Spectrum Disorders (ASD;n=46) and typically developing adolescent teenage males (TD;n=49). Boys with ASD had a higher rate of discordance in their finger print patterns than TD boys. Thus, the hypothesized prenatal disturbances that play a role in the etiology of schizophrenia and severe autism might not be specific to these severe psychiatric disorders but might also be involved in the etiology of varying degrees of ASD.

REPRODUCIBILITY OF MEASUREMENTS OF THUMB ABDUCTION

The reproducibilities of various measurements of thumb abduction were compared. Two independent observers measured the thumb abduction in 30 volunteers by the following four methods: distance between the thumb tip and the flexion crease of the index finger proximal interphalangeal joint; distance between the flexion crease of the thumb interphalangeal joint and the proximal palmar crease; angle between the thumb and index metacarpals; and angle between the thumb and index proximal phalanxes. Measurements were repeated in three weeks and their reproducibility was assessed by the intraclass correlation coefficient (ICC). Intra-observer reproducibilities by distances were high with ICCs between 0.74 and 0.89, compared with those by angles with ICCs between 0.28 and 0.71. Inter-observer reproducibilities by distances were also high (ICCs = 0.79 and 0.81) compared with those by angles (ICCs = 0.28 and 0.42). Assessment of thumb abduction based on distance in the first web is recommended in terms of reproducibility.

“FAT PAD” AND “LITTLE FINGER PULP” SIGNS ARE GOOD INDICATORS OF PROPER RELEASE OF CARPAL TUNNEL

OBJECTIVE The release of the transverse carpal ligament (TCL) for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s. Although complications are not common after the open surgical technique, a small but significant group of patients will have similar symptoms after surgery or will experience new symptoms in the postoperative period. Incomplete section of the TCL is the major cause of these complications. The authors have described two signs that confirm a complete release of the TCL, called the “fat pad” and “little finger pulp” signs. METHODS Between 2000 and 2003, we treated 643 hands in 611 patients (45 men and 566 women; age range, 32–76 yr; mean age, 58.2 yr). All patients were examined 6 months after the procedure, with special attention given to the persistence or recurrence of symptoms. The presence of palmar scar pain, residual numbness, patient satisfaction, and time to return to work were also evaluated. A longitudinal incision (2 cm) at the base of the palm was used to release the TCL. A good indicator that the distal TCL has been released is the visualization of a fatty tissue (“fat pad” sign). This fatty tissue is always present underneath the most distal fibers of the TCL, covering the sensory digital branches of the median nerve. To confirm the complete release of the proximal fibers of the TCL, we should be able to introduce the little finger pulp in a proximal direction underneath the distal flexion crease of the wrist (“little finger pulp” sign). When both signs are confirmed, we can be certain that the TCL is completely released. RESULTS Night pain disappeared immediately after surgery in all patients except three. There were seven complications (1%) not related to the palmar scar and 10 complications (1.5%) related to it. However, all of these complications disappeared an average of 3 months postoperatively. Patient satisfaction was 100%, and the mean time to return to work and full activity was 22 days (range, 14–36 d). CONCLUSION Two surgical observations that are reliable to confirm a complete release of the TCL were described. The first, called the “fat pad” sign, is useful to determine whether or not the distal end of the TCL has been adequately released, whereas the “little finger pulp” sign indicates whether or not the proximal end of the TCL has been fully divided.

Reconstruction of Fingertip Defects with the Neurovascular Tranquilli-Leali Flap

For many years, bipedicled palmar advancement flaps were used rarely in fingers because they sacrificed the dorsal branches of the digital arteries, risking dorsal skin necrosis. In 1995, a short bipedicled neurovascular VY advancement flap raised distally to the PIP flexion crease, which spared the dorsal blood supply, was described by Elliot et al. (1995) . This paper includes an anatomical study on 28 fresh cadaver fingers to evaluate the advancement potential of this flap. It also reviews 22 fingertip reconstructions in 22 patients using this flap. The mean advancement of the flap in the cadaver study was 14 (range 10–16) mm. This procedure gave good clinical results in respect of healing, sensibility, bone cover and appearance. Complications occurred in four fingers (18%), viz. two infections, one neuroma and one stiff proximal interphalangeal joint. Our study suggests that this flap can be used to treat fingertip defects of a size of approximately half of the pulp of the distal phalangeal segment of the finger.