Fist position for skin grafting on the dorsal hand: I. Analysis of length of the dorsal hand surgery in hand positions.

In skin grafting for reconstruction of burns and contracture deformities of the dorsal hand, the hand is kept in a proper position to provide the greatest amount of skin and to avoid the secondary functional deformity. The safe position has been commonly used for immobilizing the hand, but this is to protect the hand function rather than to provide maximal surface for skin grafting. Split-thickness skin graft contracts up to 30 to 50 percent of the original size owing to secondary contraction. If insufficient skin is grafted, contracture deformity of the dorsal hand may occur. To graft the greatest amount of skin on the dorsal hand, the hand should be kept preoperatively in a position flexing all joints of the wrist, metacarpophalangeal joints, and interphalangeal joints and maximally stretching the dorsal hand (a fist position). We studied the surface length of the dorsal hand between the wrist, the metacarpophalangeal joint, and the eponychium in the anatomic, safe, and fist positions of the right hand in 60 adults. Difference of total length between the anatomic and safe positions was not statistically significant (p > 0.05). The total length in a fist position was significantly increased in comparison with the other two positions (p < 0.05). In a fist position compared with the safe position, the increase in length of the dorsal surface of the proximal hand was 11 to 20 percent except in the thumb, and the increase in length of the dorsal surface of the finger was 12 to 17 percent. The increase in total length of a fist position was about 9 mm (7 to 8 percent) in the thumb and 20 to 32 mm (14 to 18 percent) in the index to little fingers. It suggests that the safe position fails to provide an increased dorsal hand surface area for skin grafting compared with the anatomic position. The greatest amount of skin can be grafted in a fist position. Hand immobilization in a fist position for 7 to 9 days after skin grafting has not resulted in irrevocable joint stiffness in our experience. If injury of the deep structures is not present, the hand should be immobilized in a fist position before skin grafting on the dorsal hand.     

The influence of gender, athletic events, and athletic experience on the subjective dominant hand and the determination of the dominant hand based on the laterality quotient (LQ) and the validity of the LQ

This study aimed to reveal the influence of gender, athletic events and athletic experience on the subjective dominant hand and the dominant hand based on the laterality quotient (LQ). It also aimed to examine the validity of the Edinburgh Inventory (Oldfield, 1971). Males and females (n=3,726) living in 7 prefectures in Japan (age: 16-45 yrs) participated in this survey. Analysis was performed on 3,557 separate datasets with high reliability. The reliability of the survey was examined using a test-retest method consisting of 100 people selected randomly from all participants. All participants provided the same answers for each question. The influence of gender, event and experience was examined for the subjective and LQ-based dominant hands. In addition, concordance rates of the subjective dominant hand and the LQ-based dominant hand and both dominant hands were examined. Differences of concordance rates between hands used in the 10 movement questions of the Inventory and the subjective dominant hand were tested using the chi(2) test. The frequency differences among items were tested using Ryan's method (multiple comparisons). Significant gender differences were found between rates of the LQ-based dominant hand (males: 94.4%; females: 96.6%) and the subjective dominant hand (males: 91.6%; females: 94.0%), but the degree was only 2.0-4.0%. Insignificant differences were found among athletic events, two groups of different athletic experience, and gender according to each athletic event. The subjective dominant hand almost always agreed with the LQ-based dominant hand (complete concordance rate=0.96, kappa=0.67). Of the 10 question items, inexperienced answers were found only in the item "Knife (without fork)". The "Toothbrush", "Broom (upper hand)", and "Opening box (lid)" items had significantly lower correspondence with the subjective dominant hand (79.7-87.0%) than the other items (92.1-95.7%).In conclusion, athletic experience appears to have little influence on handedness, although there is a slight gender difference. The subjective dominant hand almost always agrees with the dominant hand based on the Inventory. A more efficient handedness inventory may be constructed by excluding the above 4 items.     

Precision grips,hand morphology,and tools

This study asks whether there are discernable links between precision gripping, tool behaviors,

1 The term “tool behavior” has been variously used in the literature, in some cases implying exclusively tool making distinctive of humans (Susman, 1991) and in others referring variably to tool using and/or tool-making abilities, some shared with us by other animals (Susman, 1988a,b, 1994). In this paper the term is used to include both tool using and tool making behaviors of humans and non-humans; the term “tool making” is used in place of “tool behavior” whenever the discussion is focused upon distinguishing a capacity for removing flakes from stone preforms from a more general capacity to manipulate stone tools.

and hand morphology in modern hominoids, which may guide functional interpretation of early hominid hand morphology. Findings from a three-pronged investigation answer this question in the affirmative, as follows. (1) Experimental manufacture of early prehistoric tools provides evidence of connections between distinctive human precision grips and effective tool making. (A connection is not found between the “fine” thumb/index finger pad precision grip and early tool making.) (2) Manipulative behavior studies of chimpanzees, hamadryas baboons, and humans show that human precision grips are distinguished by the greater force with which objects may be secured by the thumb and fingers of one hand (precision pinching) and the ability to adjust the orientation of gripped objects through movements at joints distal to the wrist (precision handling). (3) Morphological studies reveal eight features distinctive of modern humans which facilitate use of these grips. Among these features are substantially larger moment arms for intrinsic muscles that stabilize the proximal thumb joints. Examination of evidence for these reveals that three of the eight features occur in Australopithecus afarensis, but limited thumb mobility would have compromised tool making. Also, Olduvai hand morphology strongly suggests a capacity for stone tool making. However, functional and behavioral implications of Sterkfontein and Swartkrans hand morphology are less clear. At present, no single skeletal feature can be safely relied upon as an indicator of distinctively human capabilities for precision gripping or tool making in fossil hominids. Am J Phys Anthropol 102:91–110, 1997. © 1997 Wiley-Liss, Inc.     

Evidence at hand: Diversity, functional implications, and locomotor prediction in intrinsic hand proportions of diprotodontian marsupials

Knowledge about the diversity, locomotor adaptations, and evolution of the marsupial forelimb is limited, resulting in an underrepresentation of marsupials in comparative anatomical literature on mammalian forelimb anatomy. This study investigated hand proportions in the diverse marsupial order Diprotodontia. Fifty-two measurements of 95 specimens representing 47 species, as well as 6 non-diprotodontian specimens, were explored using principal components analysis (PCA). Bootstrapping was used to assess the reliability of the loadings. Phylogenetically independent contrasts and phylogenetic ANOVA were used to test for correlation with size and functional adaptation of forelimbs for locomotor habit, scored as arboreal vs. terrestrial. Analysis of first principal component (PC1) scores revealed significant differences between arboreal and terrestrial species, and was related to relative slenderness of their phalangeal elements. Both locomotor groups displayed allometry along PC1 scores, but with different intercepts such that PC1 discriminated between the two locomotor habits almost completely. PC2 separated some higher-level clades and burrowing species. Analysis of locomotor predictors commonly applied by palaeontologists indicates that ratios between proximal and intermediate phalanges were unsuitable as predictors of arboreality/terrestriality, but the phalangeal index was more effective. From PCA results, a phalangeal slenderness ratio was developed which proved to be a useful discriminator, suggesting that a single unallocated phalanx can be used for an impression of locomotor mode in fossils. Most Diprotodontia are laterally paraxonic or ectaxonic, with the exception of digging species whose hands are medially paraxonic. Our results complement those of studies on placental mammals, suggesting that the demands of arboreality, terrestriality, or frequent digging on intrinsic hand proportions are met with similar anatomical adaptations in marsupials.     

Short term effects of weather on hand, foot and mouth disease

Background

Hand, foot, and mouth disease (HFMD) outbreaks leading to clinical and fatal complications have increased since late 1990s; especially in the Asia Pacific Region. Outbreaks of HFMD peaks in the warmer season of the year, but the underlying factors for this annual pattern and the reasons to the recent upsurge trend have not yet been established. This study analyzed the effect of short-term changes in weather on the incidence of HFMD in Singapore.

Methods

The relative risks between weekly HFMD cases and temperature and rainfall were estimated for the period 2001–2008 using time series Poisson regression models allowing for over-dispersion. Smoothing was used to allow non-linear relationship between weather and weekly HFMD cases, and to adjust for seasonality and long-term time trend. Additionally, autocorrelation was controlled and weather was allowed to have a lagged effect on HFMD incidence up to 2 weeks.

Results

Weekly temperature and rainfall showed statistically significant association with HFMD incidence at time lag of 1–2 weeks. Every 1°C increases in maximum temperature above 32°C elevated the risk of HFMD incidence by 36% (95% CI = 1.341–1.389). Simultaneously, one mm increase of weekly cumulative rainfall below 75 mm increased the risk of HFMD by 0.3% (CI = 1.002–1.003). While above 75 mm the effect was opposite and each mm increases of rainfall decreased the incidence by 0.5% (CI = 0.995–0.996). We also found that a difference between minimum and maximum temperature greater than 7°C elevated the risk of HFMD by 41% (CI = 1.388–1.439).

Conclusion

Our findings suggest a strong association between HFMD and weather. However, the exact reason for the association is yet to be studied. Information on maximum temperature above 32°C and moderate rainfall precede HFMD incidence could help to control and curb the up-surging trend of HFMD.     

Effects of posture,movement and hand load on shoulder muscle activity

The influence of external factors such as arm posture, hand loading and dynamic exertion on shoulder muscle activity is needed to provide insight into the relationship between internal and external loading of the shoulder joint. Surface electromyography was collected from 8 upper extremity muscles on 16 participants who performed isometric and dynamic shoulder exertions in three shoulder planes (flexion, mid-abduction and abduction) covering four shoulder elevation angles (30°, 60°, 90° and 120°). Shoulder exertions were performed under three hand load conditions: no load, holding a 0.5 kg load and 30% grip. It was found that adding a 0.5 kg load to the hand increased shoulder muscle activity by 4% maximum voluntary excitation (MVE), across all postures and velocities. Performing a simultaneous shoulder exertion and hand grip led to posture specific redistribution of shoulder muscle activity that was consistent for both isometric and dynamic exertions. When gripping, anterior and middle deltoid activity decreased by 2% MVE, while posterior deltoid, infraspinatus and trapezius activity increased by 2% MVE and biceps brachii activity increased by 6% MVE. Increased biceps brachii activity with gripping may be an initiating factor for the changes in shoulder muscle activity. The finding that hand gripping altered muscle activation, and thus the internal loading, of the shoulder may play an important role in shoulder injury development and rehabilitation.     

Origin of the human hand

A means of determining the phylogenetic implications of similarities between the hands of man and non-human primates is proposed. The only traits shared by man and non-human primates accepted as evidence of our ancestral hand structure and functions are those which are incompatible or out of keeping with current behavior of the human hand. They may be assumed to remain only as relics of adaptations to former habits of locomotion and feeding. The relics found through this analysis are all traits that are present in the apes (some of them only in African apes) and probably related to functions of the hand in suspension of the body, fist-walking, and knuckle-walking. The presence of these traits in man implies that human ancestors similarly used the hand to suspend the body in the trees and to support it on the back of the flexed fingers.