An isolated rupture of the flexor digitorum tendon of the index finger following volar locking plate fixation of a distal radius fracture: A case report

Volar locking plates (VLP) have been widely used recently to treat distal radius fractures and are considered the gold standard. One of the most common complications of distal radius fracture surgery is flexor pollicis longus rupture, which may also occur in other tendons. Here, we report a case of isolated rupture of the flexor digitorum profundus to the index finger after VLP fixation of a distal radial fracture. Only a few cases of this have been reported in the literature. In previously reported cases, the cause of tendon rupture was repetitive mechanical stress due to implant protrusion. In our case, the plate was placed too distally; however, soft tissue completely covered the distal part of the plate. There was obvious synovitis within the carpal tunnel; therefore, pressure within the carpal tunnel may have increased. The cause of rupture in our case was thought to be a combination of direct mechanical stress and poor circulation due to inadequate VLP fixation.

Reliability of anthropological measurements in determining vertical dimension of occlusion in Saudi population: A cross sectional study

BACKGROUND

Range of techniques have been described in traditional prosthodontics to establish Vertical dimension of occlusion (VDO). Experienced clinicians agree that there is no one single method, which is universally accepted record VDO precisely and consistently. Many facial and body landmarks have been proposed in the literature correlating to the VDO. Presence of so many methods to determine VDO further leads to confusion in the minds of clinicians. There is always a need for a research to both substantiate the findings in the literature and check reliability of such correlations in local population. Such correlation between the anthropological measurements and VDO would give clinician an evidence based approach to establish VDO during prosthetic rehabilitation. Hence this study was planned to check reliability of various anthropometric measurements in measuring VDO in a cross section of Saudi population.

MATERIAL AND METHOD

Total of 500 subjects selected for the study following an inclusion and exclusion criteria. Anthropological readings such as Index finger, Little finger, Thumb finger, Distance between Inner canthus of left eye to outer canthus of right eye and Outer canthus of the right eye to corner of mouth (rima oris) were recorded using digital Vernier caliper. The data were analyzed statistically.

RESULTS

Strong positive correlation was observed between VDO and anthropological landmarks selected in the study. Pearson's correlation test showed VDO in males has strong coefficient correlation with Index finger (r = 0.7341) and in females strong coefficient correlation with Little finger. (r = 0.5827).

CONCLUSION

In Saudi Males, VDO could be correlated to the index finger measurements followed by Thumb finger. In Saudi females subjects, VDO correlated with little finger measurements followed by outer canthus of the eye to corner of the mouth reading. It is always appropriate to use one or more methods to approximate the measurements of VDO initially and then use the other methods to test the appropriateness of the dimensions initially established.

Innervation and vascular supply of the first dorsal interosseous muscle and palmar interosseous muscle of the index: An anatomic descriptive study

INTRODUCTION

The first dorsal interosseous muscle (FDI) and palmar interosseous muscle of the index (P2I) are essential for the strength and mobility of the index finger. This study aims to describe the course of the deep branch of the ulnar nerve (DBUN) and the blood supply to these muscles.

MATERIAL AND METHODS

An anatomical cadaver study was carried out with 14 upper limbs from fresh, non-embalmed cadavers. All limbs were filled with an equal amount, based on weight, of colored silicone and diluent that was combined and catalyzed with 5% curing agent. The location of the DBUN's termination was specified relative the carpometacarpal joint. Every artery supplying either muscle was identified and documented.

RESULTS

The DBUN had a slightly convex path, distal to the hook of the hamate and penetrated the FDI muscle at an average 41% of the second metacarpal length. An average of 1.3 branches to the P2I and 2.6 branches to the FDI were found. Four artery pedicles coming from the deep palmar arch supply the FDI with an average of one consistent and exclusive pedicle to the FDI and three pedicles heading to the P2I. According to the classification of Mathes and Nahai, the FDI has a type 2 blood supply and the P2I has a type 3 blood supply.

CONCLUSION

In-depth knowledge of the vascular network supplying the FDI and P2I muscles and the course of the DBUN is essential when the DBUN is damaged or when dissecting these muscles for index pollicization.

The sole rupture of flexor digitorum tendons to the index finger following volar locking plate fixation of distal radius fracture: A case report

Distal radius fracture is a common injury, especially in elderly people, and internal fixation with volar locking plate (VLP) is becoming an increasingly popular technique for the management of displaced and/or unstable distal radius fractures. One of the most common complications of this treatment is the flexor tendon rupture, mostly of the flexor pollicis longus (FPL). While the rupture of flexor digitorum tendons to the index (FDI) mostly occurs concomitantly with the rupture of FPL after the treatment using volar plating for distal radial fracture, sole rupture of the FDI without FPL rupture is very rare. Here, we report a case of the sole rupture of FDI after volar locking plating and analyze its pathogenesis indicating that the lift-up of the distal ulnar edge of the plate related to the malcorrection of the fracture site is the culprit for this specific complication.

Traumatic index extensor tendon attenuation mimicking closed tendon rupture: two case reports

Background

While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon.

Case presentation

A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well.

Conclusions

Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

Long-term practice of isolated finger movements reduces enslaved response of tonically contracting little finger abductor to tonic index finger abduction

The purpose of this study was to elucidate whether the long-term practice of isolated finger movements reduces the enslaved response of the little finger abductor to the index finger abduction. The right-handed participants tonically or phasically abducted the index finger, while they maintained at rest or tonic abduction of the little finger. The enslaved response of the tonically contracting little finger abductor to the tonic abduction of the index finger was greater than the response of the same muscle at rest in the nonpianists. This indicates that the tonic contraction of the little finger abductor enhances the enslaving drive from the tonically contracting index finger abductor to the little finger abductor. The enslaved response of the tonically contracting little finger abductor to the tonic abduction of the index finger in the pianists was significantly smaller than that in the nonpianists, but such a significant group difference was absent when the little finger abductor was at rest. This indicates that the inhibitory process on the enslaving drive from the tonically contracting index finger abductor to the tonically active little finger abductor is unmasked through the long-term practice.

The impact of diabetic peripheral neuropathy on pinch proprioception

This study aims to investigate the impact of type 2 diabetes (T2D) and diabetic peripheral neuropathy (DPN) on pinch proprioception and to establish the correlations with sensory impairments. We collected data from a total of 36 participants (healthy, n = 12; T2D without DPN, n = 11; and T2D + DPN, n = 13), all matched for age, 60 ± 6 years. Pinch proprioception was determined through 3 trials of attempts to actively reproduce 15° of pinch position without visual feedback. Target accuracy and precision was compared between groups using Kruskal-Wallis test. Sensation was tested through the two-point discrimination and Semmes-Weinstein monofilaments applied on the fingers. Sensory measures were correlated with pinch proprioception measures via Spearman's rank test. The T2D + DPN group showed significant decrements in accuracy and precision as compared to the T2D-only (p = 0.003 and p = 0.006, respectively) and the healthy groups (both p = 0.002); no significant differences were found between T2D-only and healthy. Spearman's rank showed moderate (r = 0.45-0.66, p < 0.001) correlations between pinch proprioception and sensory measures. Our results showed pinch proprioception disruption in people with T2D + DPN, but not in people with T2D-only. The awareness of pinch proprioceptive deficits is paramount for the safety of individuals with T2D and DPN. Moderate correlations between sensory impairments and pinch proprioceptive deficits suggest that not only superficial/discriminative sensation is implicated in proprioceptive decrements. Other mechanisms such as damage to muscle spindles or central nervous system associated with T2D + DPN warrant further investigations.

The association between digit ratio (2D:4D) and overweight or obesity among Chinese children and adolescents: A cross-sectional study

BACKGROUND

The aim of this study was to analyze the relationship between 2D:4D and childhood overweight or obesity, which might indirectly show the role of prenatal hormone in childhood overweight or obesity.

METHODS

Using stratified cluster sampling approach, a school-based cross-sectional investigation was undertaken among 687 children and adolescents aged 8-15 years. Each participant's index finger (2D) and ring finger (4D) length, height, weight, testosterone, and estradiol levels were measured, and their dietary behaviors, physical and sedentary activities were also surveyed.

RESULTS

The prevalence of overweight or obesity among children and adolescents aged 8- and 12-15 years was 36.0% and 25.9%, respectively (P < 0.05). There were no associations between 2D:4D and overweight or obesity in both boys and girls (P > 0.05). However, 2D and multiplying index of digit ratio and length (MIDRL) associated directly with overweight or obesity among boys (OR (95%CI) were 1.45 (1.00, 2.14), 1.46 (1.01, 2.11), respectively), and was indirectly related to overweight or obesity by testosterone (OR were 1.30, 1.26, respectively).

CONCLUSIONS

In boys, 2D and MIDRL were directly related to overweight or obesity, and indirectly associated with overweight or obesity by testosterone, which suggested that prenatal hormone exposure might associate with overweight or obesity among boys.

Pinch aperture proprioception: reliability and feasibility study

[Purpose] To establish the reliability and feasibility of a novel pinch aperture device to measure proprioceptive joint position sense. [Subjects and Methods] Reliability of the pinch aperture device was assessed in 21 healthy subjects. Following familiarization with a 15° target position of the index finger and thumb, subjects performed 5 trials in which they attempted to actively reproduce the target position without visual feedback. This procedure was repeated at a testing session on a separate date, and the between-session intraclass correlation coefficient (ICC) was calculated. In addition, extensor tendon vibration was applied to 19 healthy subjects, and paired t-tests were conducted to compare performance under vibration and no-vibration conditions. Pinch aperture proprioception was also assessed in two individuals with known diabetic neuropathy. [Results] The pinch aperture device demonstrated excellent reliability in healthy subjects (ICC 0.88, 95% confidence interval 0.70-0.95). Tendon vibration disrupted pinch aperture proprioception, causing subjects to undershoot the target position (18.1 ± 2.6° vs. 14.8° ± 0.76, p<0.001). This tendency to undershoot the target position was also noted in individuals with diabetic neuropathy. [Conclusion] This study describes a reliable, feasible, and functional means of measuring finger proprioception. Further research should investigate the assessment and implications of pinch aperture proprioception in neurological and orthopedic populations.

Intersegmental kinetics significantly impact mapping from finger musculotendon forces to fingertip forces

Predicting the fingertip force vector resulting from excitation of a given muscle remains a challenging but essential task in finger biomechanical modeling. While the conversion of musculotendon force to fingertip force can significantly be affected by finger posture, current techniques utilizing geometric moment arms may not capture such complex postural effects. Here, we attempted to elucidate the postural effects on the mapping between musculotendon force and fingertip force through in vitro experiments. Computer-controlled tendon loading was implemented on the 7 index finger musculotendons of 5 fresh-frozen cadaveric hands across different postures. The resulting fingertip forces/moments were used to compute the effective static moment arm (ESMA), relating tendon force to joint torque, at each joint. The ESMAs were subsequently modeled in three different manners: independent of joint angle; dependent only upon the corresponding joint angle; or dependent upon all joint angles. We found that, for the reconstruction of the fingertip force vector, the multi-joint ESMA model yielded the best outcome, both in terms of direction and magnitude of the vector (mean reconstruction error <4° in direction and <2% in the magnitude), which indicates that intersegmental force transmission through a joint is affected by the posture of neighboring joints. Interestingly, the ESMA model that considers geometric changes of individual joints, the standard model used in biomechanical stimulations, often yielded worse reconstruction results than the simple constant-value ESMA model. Our results emphasize the importance of accurate description of the multi-joint dependency of the conversion of tendon force to joint moment for proper prediction of fingertip force direction.

Comparative evaluation of maxillary and mandibular anterior teeth width with the length of index and little finger

The size, color, morphology and arrangement of the anterior tooth are the various factors play an imperative role in achieving excellent esthetics in complete denture. Various modalities have been suggested for selecting the size of the anterior teeth like inter-alar distance, inter-canthal distance, bi-zygomatic width, intercanine width. There is no reliable method for selection of anterior teeth etc. To evaluate and compare the width of the maxillary and mandibular anterior teeth with the length of the index and little fingers. total of 50 people were taken for this study. They are grouped into four, Group I, 15-20 years; Group II, 20-30 years; Group III, 30-40 years; Group IV, 40-50 years. Irreversible hydrocolloid impressions of the maxilla and mandible were made and poured with dental stone. The widths of the maxillary and mandibular anterior teeth were measured with an adaptable ruler. The length of the index and little fingers were measured using a vernier caliper. There is significant correlation between the maxillary and mandibular anterior teeth with the index and little finger length.

CONCLUSION

The maxillary anterior teeth width can be calculated with the formula (1.130 × index finger length - 11.972), mandibular anterior teeth width can be calculated with the formula (1.006 × little finger length - 2.231).