The cross-hand finger transfer.

This report is of the first successful case we know of transplantation of a ray (finger and metacarpal) from one hand to another. The transfer was accomplished by a two-stage pedicle technique. The tendons and nerves were left long in the donor finger, and were anastomosed at the second stage when the pedicle was divided. Good sensation was obtained. Active tendon function resulted, with excellent power and range of motion in all of the digits of both hands.     

A versatile one-stage neurovascular flap for fingertip reconstruction: the dorsal middle phalangeal finger flap.

The dorsal middle phalangeal finger flap is an extremely reliable flap that is indicated for fingertip injuries which require sensory reconstruction. This flap originates from the dorsum of the middle phalanx of the finger and is elevated with a vascular pedicle of the digital artery and the dorsal branch of the digital nerve. After transfer of the flap to the injured site, epineural neurorrhaphy is done between the digital nerve and the dorsal sensory branch of the flap. This flap can be thought of as an island flap of the innervated cross-finger flap that provides excellent sensory recovery and aesthetic improvement. We used this flap in a series of eight consecutive patients and were able to follow up seven patients for longer than 6 months (mean follow-up time 10.7 months). All patients achieved measurable two-point discrimination, with an average of 4.9 mm in the moving two-point discrimination. In this study, we report our consecutive series of the dorsal middle phalangeal finger flap and its versatile utility.     

Congenital synostosis of the fourth and fifth metacarpals treated by free bone grafting from the fusion site

Simultaneous correction of the alignment and the shortening of the deformed little finger in congenital synostosis of the fourth and fifth metacarpals was accomplished by insertion of a wedge-shaped bone block harvested from the fusion site following transverse osteotomy of the fifth metacarpal. Correction can be performed simply and successfully without morbidity of the donor site when this technique is applied to suitable patients.     

A resampling approach and implications for estimating the phalangeal index from unassociated hand bones in fossil primates

Primate fossil assemblages often have metacarpals and phalanges from which functional/behavioral interpretations may be inferred. For example, intrinsic hand proportions can indicate hand function and substrate use. But, estimates of intrinsic hand proportions from unassociated hand elements can be imperfect due to digit misattribution. Although isolated metacarpals can be identified to a specific digit, phalanges are difficult to assign to a specific ray. We used a resampling approach to evaluate how estimates of intrinsic hand proportions are affected by such uncertainty. First, the phalangeal index—intermediate phalanx length plus proximal phalanx length divided by metacarpal length—for the third digit was calculated for associated specimens of terrestrial, semiterrestrial, and arboreal taxa. We then used resampling procedures to generate distributions of “composite digits” based on resampled ratios in which phalanges from the second, fourth, and fifth rays, and from different individuals, were chosen randomly. Results confirm that the phalangeal index for associated third digits significantly discriminates groups. We also found that resampled ratios had significantly lower means, indicating that using composite digits is prone to systematic underestimation. Resampled ratios also generated distributions with greater variance around the means that obscured distinctions between groups, although significant differences between the most arboreal and terrestrial taxa are maintained. We conclude that using unassociated phalanges to calculate a phalangeal index is prone to sampling bias. Nevertheless, a resampling approach has the potential to inform estimates of hand proportions for fossil taxa, provided that the comparative sample is constrained to mimic the fossil composition. Am J Phys Anthropol 151:280–289, 2013. © 2013 Wiley Periodicals, Inc.     

A new island flap transfer from the dorsum of the index to the thumb.

We describe here a new island flap from the dorsum of the index finger, transferred on the first dorsal metacarpal artery with one or two veins and the terminal branches of the radial nerve. This vascular bundle is a reliable one, for we have had no necrosis in 12 consecutive cases. The quality of its venous outflow and the use of a dorsal donor site give it advantages over the Moberg-Littler island flap, unless a dorsal vein from the latter flap is preserved and sutured to a vein in the recipient site. The arterial vascularization without any skin pedicle makes this "kite" flap a more practical one than the "flag" flaps of Vilain or Holevitch or Kuhn. Finally, a one-stage transfer is usually preferable to a two-stage one (e.g. Adamson, Braillar). In a single operation, this transfer provides composite resurfacing of the thumb while bringing in new blood and nerve supply.     

The Consequences of Habitual Knuckle Cracking

Habitual knuckle cracking in children has been considered a cause of arthritis. A survey of a geriatric patient population with a history of knuckle cracking failed to show a correlation between knuckle cracking and degenerative changes of the metacarpal phalangeal joints.     

Rehabilitation process and functional results of patients with amputated fingers

Digit amputation is a physical and psychological trauma that can influence the daily living of a person. The rehabilitation of patients with digit amputation is a complex process and should take into consideration all influencing factors, such as the functional, emotional, social, and professional profile of the patient. This study was conducted to evaluate the functional level of patients with amputated fingers and to understand the factors that influence their rehabilitation. Fifty patients (42 male and 8 female with an age ranging from 7 to 84 years) who had digit amputation(s) between January of 1990 and December of 1998 at the level of the metacarpus or distal to it and who had at least 6 months of follow-up were examined. The patients were divided into three different study groups: patients with distal amputation were compared with patients who had proximal amputation, patients with one finger amputation were compared with patients who had multiple finger amputations, and patients who suffered finger amputations caused by work-related accidents were compared with those who suffered amputations caused by other incidents. In addition, the time lapse from the amputation was checked as an influencing factor for different functional levels. The results showed that patients with distal amputation reached a higher motor and sensory functional level than patients with proximal amputation. Patients with one-finger amputation reached higher motor, sensory, and activities of daily living functional levels than patients with multiple amputations, and the level of motor and sensory function of patients with finger amputations caused by work-related accidents was lower than that of patients who suffered amputations in other incidents. Time was proven to be an important factor in the process of motor and emotional recovery.     

Pollicization

Congenital absence or traumatic amputation of the thumb is a major disability profoundly disturbing the function of the hand, as the thumb represents an estimated 50% of total hand function. The methods for thumb reconstruction utilizing the index finger were developed some twenty years ago, and progress has been made in the last several years with emphasis on intrinsic muscle reconstruction as emphasized by Buck-Gramcko. The method, technique and anatomy of index pollicization is discussed, and representative cases presented for congenital absence of the thumb and for traumatic amputation of the thumb.     

Chondromyxoid fibroma of the second metacarpal bone--a case report

This report describes a chondromyxoid fibroma of the second metacarpal bone in a 32-year-old female patient. Chondromyxoid fibroma is a rare, benign, slow-growing bone tumor of cartilaginous origin. Tumor has a high recurrance rate. Our aim was to show successful treatment of a metacarpal chondromyxoid fibroma with wide resection and implantation of finger join endoprosthesis.     

Novel deletion mutation of TRPS1 gene in a Chinese patient of trichorhinophalangeal syndrome type I

Tricho–rhino–phalangeal syndrome (TRPS) is a rare autosomal dominant disorder. Deletion or mutation of the TRPS1 gene leads to the tricho–rhino–phalangeal syndromes type I or type III. In this article, we describe a Chinese patient affected with type I TRPS and showing prominent pilar, rhinal and phalangeal abnormalities. Mutational screening and sequence analysis of TRPS1 gene revealed a previously unidentified four-base-pair deletion of nucleotides 1783–1786 (c.1783_1786delACTT). The mutation causes a frame shift after codon 593, introducing a premature stop codon after 637 residues in the gene sequence. This deletion is an unquestionable loss-of-function mutation, deleting all the functionally important parts of the protein. Our novel discovery indicates that sparse hair and metacarpal defects of tricho–rhino–phalangeal syndromes in this patient are due to this TRPS1 mutation. And this data further supports the critical role of TRPS1 gene in hair and partial skeleton morphogenesis.     

Analysis of musculoskeletal loading in an index finger during tapping

Since musculoskeletal disorders of the upper extremities are believed to be associated with repetitive excessive muscle force production in the hands, understanding the time-dependent muscle forces during key tapping is essential for exploring the mechanisms of disease initiation and development. In the current study, we have simulated the time-dependent dynamic loading in the muscle/tendons in an index finger during tapping. The index finger model is developed using a commercial software package AnyBody, and it contains seven muscle/tendons that connect the three phalangeal finger sections. Our simulations indicate that the ratios of the maximal forces in flexor digitorum superficialis (FS) and flexor digitorum profundus (FP) tendons to the maximal force at the fingertip are 0.95 and 2.9, respectively, which agree well with recently published experimental data. The time sequence of the finger muscle activation predicted in the current study is consistent with the EMG data in the literature. The proposed model will be useful for bioengineers and ergonomic designers to improve keyboard design minimizing musculoskeletal loadings in the fingers.     

Froghood: Postmetamorphic development of the rock river frog Thoropa miliaris (Spix, 1824) (Anura,Cycloramphidae)

Thoropa miliaris is a frog species endemic to the Brazilian Atlantic Rainforest, inhabiting wet rocky habitats. Males of this species present nuptial excrescences, which are keratinized spines on the surface of some fingers and internal metacarpal tubercles. Although these spines are usually associated with male adulthood, no details of their development are available. To investigate the sequence of spines' appearance, we correlated the number of spines with size and age, which was estimated by skeletochronology. We studied individuals collected from Rio de Janeiro, Brazil. There was significant correlation between size of individuals and number of spines and between age and number of spines in the callosities. The first spines appeared in metacarpal–phalangeal articulation of finger II, when specimens were 1 year old. The estimated growth curve did not show stabilization at any age. We considered the degree of development of the nuptial excrescences as a proxy for sexual maturity and so individuals may already be sexually active by 1 year of age. Estimated longevity of T. miliaris is similar to that estimated for other tropical species of frogs. Although growth in anuran species is considered to be undetermined, in T. miliaris, it seems to fit either undetermined or determined models.     

Distribution of middle phalangeal hair in a population of the south of Spain

In this paper the presence or absence of middle phalangeal hair has been studied in an Andalusian population sample. This sample consists of 245 students from Granada (128 males and 117 females). The frequencies of middle phalangeal hair are similar to those obtained in the Basque population, which show the lowest frequencies so far reported. In our sample no significant sexual or bimanual differences are seen. The most affected finger is the ring-finger, the least affected one is the forefinger. The phenotypes were classified according to the nomenclatures given by Valls and Bernstein.     

Measurements of wrist and finger postures: a comparison of goniometric and motion capture techniques

A marker-based kinematic hand model to quantify finger postures was developed and compared to manual goniometric measurements. The model was implemented with data collected from static postures of five subjects. The metacarpal phalangeal (MCP) and proximal interphalangeal (PIP) joints were positioned in flexion of approximately 30, 60, and 90 degrees for 5 subjects. Wrist flexion/extension and ulnar/radial deviations were also examined. The model-based angles for the MCP and PIP joints were not statistically equivalent to the goniometric measurements, with differences of -1.8 degrees and +3.5 degrees, respectively. Differences between the two measurement methods for the MCP and PIP were found to be a function of the posture (i.e., 150, 120, or 90 degree blocks) used. Wrist measurements differed by -4.0 degrees for ulnar/radial deviation and +5.2 degrees for flexion/extension. Much of the difference between the model and goniometric measurements is believed due to inaccuracies in the goniometric measurements. The proposed model is useful for future investigations of finger-intensive activities by supplying accurate and unbiased measures of joint angles.     

Thumb reconstruction with a sensory flap from the dorsum of the index finger.

The dorsal skin of the index ray is very useful (1) for a one-staged thumb lengthening procedure after amputation, (2) for covering the stump of an avulsed thumb with sensory skin, and (3) for expanding the first web space. The flap may be transferred as a rotation flap, or the dorsal vasculature and nerve supply to the index may be carefully dissected free as a pedicle to permit its use as a neurovascular island flap. We believe that considerably more sensory skin can be transferred by this flap than by the ring finger neurovascular island flap, and that the technical risks and surgical time are less with the index finger flap.     

Minimizing impairment in laborers with finger losses distal to the proximal interphalangeal joint by second toe transfer

Traditionally, toe-to-hand transfers have been reserved for thumb amputations or for use after severe mutilating injuries. The authors report their experience with the use of second toe-for-finger amputations with preserved or reconstructible proximal interphalangeal joints in manual workers. The aim of the procedure was to reduce impairment and to upgrade the hand from a functional and cosmetic standpoint. Fifteen second-toe wrap-around or variations were carried out on 11 adults (18 to 41 years old). Four patients with two or more finger amputations received two sequential second toes; four patients with two finger amputations received one toe; and each of three patients with single-digit amputation received a single toe. All but one amputation were performed less than 3 weeks after the accident. All toes survived. Range of motion at the native proximal interphalangeal joint was more than 90 percent in all patients but one; however, it was minimal at the transplanted joints. Patient satisfaction was high from a cosmetic and functional standpoint. Ten of 11 laborers resumed their previous activity. On the basis of this experience, a classification with aesthetic and functional implications is proposed to help in the decision-making process when dealing with multidigital injuries. It is concluded that second-toe transfer is an excellent choice for finger amputation distal to the proximal interphalangeal joint in laborers. Its prime indication is for amputations of two fingers where at least one toe should be transferred, as required, to achieve an "acceptable hand" (three-fingered hand). Early transfer allows salvage of critical structures from the damaged finger, such as joints, tendons, and bone, that otherwise would be lost. Early transplantation is highly recommended.     

Thumb reconstruction in children through metacarpal lengthening

In 7 children, aged 10 to 14 years, we did thumb reconstructions by a gradual lengthening of the first metacarpal. In all cases, spontaneous bone consolidation occurred between the distracted fragments. The average period of treatment was 4 months, and a mean metacarpal elongation of 88% was achieved. The quality of the skin sensitivity in the amputation stump was preserved after the lengthening.     

Amputation of the middle ray in the primary treatment of severe injuries of the central hand

Severe injury to the middle finger often compromises both the appearance and function of the hand. This report discusses the use of total middle ray amputation at the time of primary trauma surgery to avoid predictable problems that arise when the ray, or part of it, is retained. Primary ray amputation eliminates the defective middle finger, avoids a gap hand, and reunites the dissociated radial and ulnar segments of the hand to create a useful, three-fingered hand.     

Evolutionary morphology of the Tenrecoidea (Mammalia) carpal complex

The mammalian carpus can be difficult to interpret both phylogenetically and functionally. It is evolutionarily constrained in terms of functional morphology, yet there is considerable variation among many eutherian and metatherian lower and higher level taxa. The ecologically diverse Tenrecoidea (Mammalia) is a useful model for morphological interpretation of the interplay between function and phylogenetic constraint. Elements from the wrist and hand of 13 tenrecoid species, and one species each from Macroscelididae, Solenodontidae, and Erinaceidae, were compared to test form–function hypotheses of specific carpal, metacarpal, and phalangeal characters. Qualitative comparisons illustrate that several aspects of the tenrecoid carpus can be correlated with positional behaviour. Convergences within Tenrecoidea, and between tenrecoids and nontenrecoids with similar locomotor regimes, confirm a small number of carpal characters and a larger number of distal forearm, metacarpal, and phalangeal characters that reliably correspond with functional expectations. In addition, several features of the carpus appear to be phylogenetically constrained and indicate specific affinities within Tenrecoidea. Finally, there are a significant number of carpal features that vary among the studied taxa and remain ambiguous in terms of phylogenetic and/or functional significance.  © 2008 The Linnean Society of London, Biological Journal of the Linnean Society , 2008, 93 , 267–288.     

Pentadactyl pattern of the avian wing autopodium and pyramid reduction hypothesis

We report herein that a pentadactyl developmental pattern is evident in early wing morphogenesis of Gallus (chicken) and Struthio (ostrich). Five avascular zones (spatially predestined locations of contiguous metacarpal and phalangeal aggregation) and four interdigital vascular spaces are established by the regression patterns of autopodial vasculature. Transient vestiges of the first and fifth metacarpals are confirmed histologically and histochemically. They lie within the preaxial-most and postaxial-most avascular zones, respectively. These observations reveal conservative patterning of the avian hand and corroborate a II-III-IV metacarpal interpretation, argue for II-III-IV identity of ossified digits in birds, and favour a simple reduction rather than a homeotic shift in terms of the phenotype expressed by Hox genes in the phylogeny of the avian manus. We suggest that gradual, bilateral reduction of phalanges and metacarpals, via apoptosis mediated by BMP, occurred during the evolution of birds (Pyramid Reduction Hypothesis). This is congruent with the establishment of a central wing axis that became co-opted for coordinated movements. On the basis of evidence presented here, the direct avian ancestor is predicted to have been five-fingered with dominant digits (+ metacarpals) as follow: II, III, IV.