A turret exostosis was known a smooth, dome-shaped extracortical collection of subperiosteal bone beneath the extensor apparatus. In most cases, turret exostosis involve middle and distal phalanges compared with involving metacarpal cases have been rarely reported in the literature.
Exostoses ; Metacarpus

Avascular necrosis of the metacarpal head named as 'Dieterich disease' is a very rare condition. Because of the lack of information about the natural course and treatment of this disease, the ideal treatment has not been established as yet. We report a case of avascular necrosis that occurred at the 3rd metacarpal head after fractures of the 4th and 5th metacarpal base; this was treated conservatively and obtained the spontaneous resolution.
Head ; Metacarpal Bones ; Metacarpus ; Necrosis ; Osteonecrosis

This study proposed an assessment of the correlation of hand bone mineral density measured by dual energy x-ray absorbtiometry (DXA) with the carpo:metacarpal (C:MC) ratio and metacarpal cortical index (CI) in patients with rheumatoid arthritis (RA). The correlation of total hand BMD, CI and C:MC ratio with BMD at other sites, the Health Assessment Questionnaire (HAQ) and Larsen scores were also examined. The hand and axial BMD of 30 female patients were also compared with 29 age-matched healthy female controls. Total hand BMD values of patients were significantly lower than the control group. There was no significant difference between groups in axial measurements. CI correlated moderately with the second metacap (II.MC) midshaft and total hand BMD. The C:MC ratio correlated with II.MC midshaft and total hand BMD. Total hand BMD correlated moderately with the AP spine (L2-L4) and femoral neck BMD. Larsen scores showed weak negative correlation with II.MC midshaft BMD and CI. Grip strength correlated weakly only with total hand BMD. The results indicated that CI may reflect cortical bone mass of the hand accurately and did not predict bone density of the spine or hip in patients with RA. The C:MC ratio is a useful method for evaluating progression of wrist involvement and may be related to the loss of hand bone mineral density associated with disease process.
Adult ; Aged ; Arthritis, Rheumatoid/metabolism* ; Bone Density* ; Female ; Hand* ; Human ; Metacarpus/metabolism* ; Middle Age

Adolescent ; Adult ; Female ; Fracture Fixation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpus ; injuries ; Middle Aged

OBJECTIVES: To study the injury manners of Bennett fracture and Rolando fracture and explore its identification principle of the first metacarpal base fractures. METHODS: Totally 31 cases of Bennett fracture and Rolando fracture were collected. The injury manners of cases of 19 Bennett fractures and 12 Rolando fracture were classified, and various injury manners were analysed statistically. RESULTS: The injury manners of the cases of 19 Bennett fracture and 12 Rolando fracture were divided into three types, including the first metacarpus hit hard objects during a punching, the first metacarpus hit hard objects when making fists and fell, or the first metacarpus was punched by hard objects when making fists. CONCLUSIONS The injury mechanism of Bennett fracture and Rolando fracture is formed by a force on the first metacarpus when making fists, which transmits to the basilar part along the vertical axis of metacarpus. The inference of injury manners should be focused on the confirmation of entrusted matters.
Epiphyses ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Humans ; Joint Dislocations/surgery* ; Metacarpus/injuries* ; Thumb/injuries*

Bone Diseases, Developmental ; diagnosis ; surgery ; Female ; Humans ; Metacarpal Bones ; diagnostic imaging ; surgery ; Metacarpus ; diagnostic imaging ; surgery ; Middle Aged ; Radiography

PURPOSES: Radiologic findings of hands in Turner syndrome(TS) which have been reported were metacarpal sign(MS), carpal sign(CS), phalangeal sign(PS), osteopenia, and delayed bone maturation. The aim of this study is to evaluate the difference of radiologic findings in TS, idiopathic short stature(ISS), and growth hormone deficiency(GHD). METHODS: Sixty girls with short stature were studied for chromosome analysis, and growth hormone provocation test. Simple radiography of hands was also used in this study. They were divided into three groups; 25 cases of TS(45, XO, 13 cases; variants, 12 cases), 24 cases of ISS, and 11 cases of GHD. MS was the distance between the line drawn tangential to the heads of the fourth and fifth metacarpal bones and the distal end of the third metacarpal head. CS was the angle between the line tangential to scaphoid and lunate and the line tangential to lunate and triquetrum. PS was the difference between the sum of the length of distal and proximal phalanges of the fourth finger and the length of the fourth metacarpus. Frequency of osteopenia and the shortening of the fifth middle phalanx among three groups were compared. RESULTS: MS was 0.06+/-4.66 mm in TS, -1.96+/-1.83 mm in ISS, and -2.63+/-30 mm in GHD. CS was 116.54+/-11.52degreein TS, 129.42+/-5.52degreein ISS, and 125.54+/-7.22degreein GHD. PS was 0.52+/-0.34 mm in TS, 0.38+/-0.20 mm in ISS, and 0.33+/-0.20 mm in GHD. There were statistically significant differences between TS and ISS, between TS and GHD, respectively in MS, CS, and PS(P<0.05). There were no significant differences in MS, CS, and PS between 45, XO and variants of TS. Osteopenia was observed in 92.3% of TS, and 54.2% of ISS, and 81.8% of GHD. Shortening of the fifth middle phalanx was observed in 56.0% of TS, 25.0% of ISS, and 45.5% of GHD. CONCLUSION: Simple radiologic findings of hands are helpful in differential diagnosis of TS and other short stature children.
Bone Diseases, Metabolic ; Child ; Diagnosis, Differential ; Female ; Fingers ; Growth Hormone ; Hand* ; Head ; Humans ; Metacarpal Bones ; Metacarpus ; Radiography ; Turner Syndrome*

OBJECTIVETo investigate the treatment of the displaced neck and subcapital fractures of the fifth metacarpal.

METHODSThirty-one patients with the neck and subcapital fractures of the fifth metacarpal had been operated on with antegrade intramedullary fixation between January and August 2005. There was 11 subcapital fractures (group A), and 20 neck fractures (group B). Following closed reduction of the fracture, a blunt 2.0 mm diameter K-wire, which was pre-bent into 20 degrees at the distal end, was inserted into the medullary canal of the fifth metacarpal and fixed the fractures. Postoperatively, patients in group A were immobilized in a short arm plaster splint for 4 weeks, and the ones in group B were treated with unrestricted mobilization.

RESULTSOperative time was 18 min averagely (range 5 to 30 min). Twenty-nine of 31 patients obtained anatomic reduction, and 2 patients had 2/3 apposition of bone end and no rotational deformity. Follow-up was available for all patients. The average follow-up interval was 4 months, with a range of 3 - 6 months. The head/shaft angle of the fifth metacarpal in group A was 63.4 degrees +/- 14.5 degrees preoperatively, and 15.0 degrees +/- 2.5 degrees postoperatively, and 15.4 degrees +/- 2.6 degrees in 3 months postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 89.5 degrees +/- 4.3 degrees postoperatively, which was not significantly different compared with that of uninjured side. The head/shaft angle in group B was 59.1 degrees +/- 10.0 degrees preoperatively, and 15.9 degrees +/- 2.5 degrees postoperatively, and 15.5 degrees +/- 2.8 degrees in 3 months postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 88.6 degrees +/- 3.6 degrees postoperatively, which was not significantly different compared with that of uninjured side.

CONCLUSIONSThe technique is technically easy to perform, minimally invasive, low-cost, allowing early hand mobilization, with good functional results and low morbidity, and it has been proved to be an ideal method.

Adolescent ; Adult ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpus ; injuries ; Treatment Outcome

We reported a 30 years old man who suffered a bite wound of the right hand in a fight. Two days after the injury, he was admitted in emergency because of stab wound above the head of the third metacarpal bone. He presented the swelling, redness, pain and fever. Primary revision confirmed only partial lesion of the extensor apparatus. During the following days, we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the thirdmetacarpophalangeal joint. The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics. After resolution of clinical and laboratory findings, the wound was finally closed by delayed primary suture. Clenched fist injury is a medical emergency that requires immediate surgical revision. We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes.
Adult ; Arthritis, Infectious ; etiology ; therapy ; Bites, Human ; complications ; Humans ; Male ; Metacarpophalangeal Joint ; injuries ; Metacarpus ; injuries ; Negative-Pressure Wound Therapy ; Osteomyelitis ; etiology ; therapy

OBJECTIVETo evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.

METHODSFrom 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90 cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.

RESULTSIn the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours, colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery (British Medical Research Council, BMRC), the sense function of the flaps resumed S3 after operation for 1 year. In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.

CONCLUSIONSTo soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries. Postoperative flap color and texture are similar to normal fingers.

Adolescent ; Adult ; Aged ; Child ; Female ; Finger Injuries ; surgery ; Graft Survival ; Humans ; Male ; Metacarpus ; surgery ; Middle Aged ; Retrospective Studies ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome