Comparative morphology of the pollical distal phalanx

Functional analysis of human pollical distal phalangeal (PDP) morphology is undertaken to establish a basis for the assessment of fossil hominid PDP morphology. Features that contribute to the effectiveness of grips involving the distal thumb and finger pulp areas include: 1) distal thumb interphalangeal joint morphology, facilitating PDP conjunct pronation with flexion; 2) differentiation of a proximal, mobile pulp region from a distal, stable pulp region, providing for firm precision pinch grips and precision handling of objects; and 3) asymmetric attachment of the flexor pollicis longus (FPL) tendon fibers, favoring PDP conjunct pronation. A proportionately larger size of the ulnar vs. radial ungual spine suggests differential loading intensity of the ulnar side of the proximal ungual pulp and supporting nail bed. Stresses at the distal interphalangeal joint are indicated by the presence of a sesamoid bone within the volar (palmar) plate, which also increases the length of the flexor pollicis longus tendon moment arm. Dissections of specimens from six nonhuman primate genera indicate that these human features are shared variably with individuals in other species, although the full pattern of features appears to be distinctively human. Humans share variably with these other species all metric relationships examined here. The new data identify a need to systematically review long-standing assumptions regarding the range of precision and power manipulative capabilities that might reasonably be inferred from morphology of the distal phalangeal tuberosity and from the FPL tendon insertion site on the PDP.     

Inverted-U incision for exploration of the distal phalanx

A representation of a modified inverted-U incision over the dorsal aspect of the distal phalanx is presented. The incision consists of a curved, proximally based U-shaped flap and provides direct exposure of the extensor terminal tendon and distal joint articulation. Since the flap is proximally based, there is no danger of vascular compromise. It gives an excellent exposure without having to struggle with retractors, and it can be performed without the aid of an assistant. In our series, there has not been a single incident of complication, and the favorable appearance after healing makes this incision one of our favorites.     

Osteoid osteoma of the distal phalanx of the finger: a diagnostic challenge.

Osteoid osteomas of the distal phalanx of fingers are uncommon. An extensive review of the literature indicates that the diagnosis of osteoid osteoma of the distal phalanx is often delayed for several months to years (average 34.3 months). Pain is the most common finding (92 percent), followed by swelling and clubbing (75 percent). Relief of pain by aspirin was indicated in 10 patients (42 percent). Multiple operations were done in 7 patients prior to the appropriate diagnosis and treatment. A typical case report is presented to illustrate the difficulties in diagnosis and treatment of this benign bone tumor. A better awareness of this tumor may prevent unwanted delays in diagnosis and unnecessary operations.     

The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers.

Microvascular replantation at the distal phalangeal level has recently been reported by several authors, but as yet the rate of success has not been constant owing to the technical difficulties associated with small vessels. To solve this problem, over the last 4 years we have used arteriovenous anastomosis to reestablish either the arterial system or the venous drainage system in the 33 digits of our 23 patients. The results have been excellent, with a 91 percent success rate. Such results for replantation of the distal phalanx may be maintained and improved if a small venous graft with several branches is also utilized.     

Shape variation of the human pollical distal phalanx and metacarpal

Human distal pollical phalanx form has been associated with tool manufacture, and the broad tuft of this bone in Neanderthals has been suggested to be a climatic adaptation and/or an aid to a tremendously powerful grip. A wide first metacarpal head has also been proposed to be useful in distinguishing tool-dependent hominids from those less reliant on tools. In order to contribute to an evaluation of these hypotheses variation in first metacarpal and distal phalanx shape is explored among samples of modern humans and compared to that of fossil hominids. Modern humans are from the Terry Collection, Larsen Bay, a Chinese-Alaskan cemetery, Egypt, and Sully and Mobridge. Hominid fossils include AL 333w-39, SKX 5016, SK 84, Stw 294, OH 7, several Neanderthals, Skhūl 4 and 5, and Predmostí 3. Analysis involves length-width ratios, regressions of distal phalanx tuft width on base width and of metacarpal head width on length, and pattern profiles based on Z-scores with reference to the Larsen Bay sample. Larsen Bay individuals are robust, while Terry "blacks," Egyptians, and Chinese-Alaskan males tend to be gracile. Fossil hominids are most distinctive for distal phalanx radioulnar tuft and mid-shaft widths relative to length. Security of grip is one plausible explanation. While most modern samples are positively allometric for tuft width relative to base width, the Larsen Bay and fossil hominid samples are not; thus caution is advised in accepting a base-tuft width comparison as a tool-dependence marker. Separation from modern humans is not easily achieved with metacarpal measures, but the Hadar metacarpal has distinctively narrow radioulnar head width ratios. While first metacarpal head expansion among hominids may plausibly be related to tool manufacture, other activities that place stress on the metacarpophalangeal joint should also be considered.     

The boomerang flap in managing injuries of the dorsum of the distal phalanx

Finding an appropriate soft-tissue grafting material to close a wound located over the dorsum of a finger, especially the distal phalanx, can be a difficult task. The boomerang flap mobilized from the dorsum of the proximal phalanx of an adjacent digit can be useful when applied as an island pedicle skin flap. The vascular supply to the skin flap is derived from the retrograde perfusion of the dorsal digital artery. Mobilization and lengthening of the vascular pedicle are achieved by dividing the distal end of the dorsal metacarpal artery at the bifurcation and incorporating two adjacent dorsal digital arteries into one. The boomerang flap was used in seven individuals with injuries involving the dorsal aspect of the distal phalanx over the past year. Skin defects in all patients were combined with bone,joint, or tendon exposure. The authors found that the flap was reliable and technically simple to design and execute. This one-step procedure preserves the proper palmar digital artery to the fingertip and has proven valuable for the coverage of wide and distal defects because it has the advantages of an extended skin paddle and a lengthened vascular pedicle. When conventional local flaps are inadequate, the boomerang flap should be considered for its reliability and low associated morbidity.     

The ligaments of the fingers. Anatomical study of the Cleland ligaments

The aim of this study was to establish a precise architecture of the retinacular ligaments of human digits. Sixty selected digits from human cadavers aged 40-70 years were used in this study. We were able to identify, under the dissecting microscope, two distinct ligamentous complexes: one proximal of greater importance and the other distal of lesser importance. Both structures extend from the periosteum as well as from the fibrous part of the digital sheath to the skin. There are many variations in size and in shape of these structures but they are not related to a particular digit. The role of these ligaments is to prevent the 'effet de doigt de gant', to stabilize and to maintain the neurovascular bundle of the digit at the moment of the digital flexion.     

Collateral ligaments of the distal sesamoid bone in the digit of Equus: re-evaluating midstance function

The distal forelimb of the horse has a complex array of ligaments that play a critical role in determining function of the digit and are often associated with the initiation of foot pathologies. The collateral ligaments of the distal sesamoid bone (CLDS) play an important role in digit stabilization near the end of foot contact and there is also limited evidence to suggest that the CLDS stabilize the proximal interphalangeal joint (PIPJ) during weight bearing. By virtue of their anatomical attachments where the ligaments pass dorsal to the axis of rotation of the PIPJ, it is reasonable to assume that the CLDS prevent flexion of the PIPJ during weight bearing or midstance in a moving horse. To test this functional hypothesis, forelimb specimens from three mixed-breed horses were loaded in compression in a materials testing frame. Limb loading was applied with the CLDS intact and following transection. Average PIPJ angle and metacarpophalangeal joint (MCPJ) angle at maximum load (approximately 3000 N) were calculated from angular changes of proximal and middle phalanges and the third metacarpal, which were compared between intact and transected trials. PIPJ angles were found to be the same (175 degrees) at maximum load for intact and transected trials. The proximal and middle phalanges rotated together remaining aligned, regardless of the CLDS condition. Contrary to expectation, however, the combined proximal and middle phalanges unit rotates less relative to the third metacarpal under load after transection, indicating less digit extension at the metacarpophalangeal (fetlock) joint without the influence of CLDS. Since the mechanical properties of the fetlock joint are unchanged by CLDS transection, observed proximal and middle phalanx motion is dependent on increased rotation of the distal phalanx after transection. The original hypothesis was not supported and the results suggest that at midstance the CLDS function primarily to stabilize the articulation of the middle phalanx about the distal phalanx to limit distal interphalangeal joint extension during weight bearing. Establishing the functional role of the CLDS may help to better understand the biomechanical consequences of ligament injuries and diseases of the pastern.     

Reflex from the ankle ligaments of the feline.

It was found that two to three articular branches of the tibial nerve innervate the medial ligament of the feline ankle. No innervation was found to the laterial ligament. Supramaximal electrical stimulation of the articular nerves was found to elicit electromyographic (EMG) activity in the intrinsic muscles of the foot. EMG activity was not found in any of the calf muscles which cross the ankle. The average time delay from stimulus to EMG activity was 3.8 ms, indicating that a fast, bisynaptic reflex is active, probably for purposes of preventing or correcting foot eversion to maintain joint stability.     

Stiffness of the ligaments of the human wrist joint.

In the present study the stiffness of the superficial ligaments of 14 human cadaver wrist joints have been determined. In these experiments the tested, fresh-frozen carpal joints are divided into a number of bone-ligament-bone complexes, which are loaded in a tensile testing machine at a rate of 66% of the ligaments' initial length per second to a maximal strain of 15%. From the force-elongation curves and ligament dimensions the tangent moduli for the ligament-bone strips are derived. The results show that, with regard to the tangent modulus, there is not a clear differentiation among ligament strips. Only the dorsal radiotriquetrum ligament (RTD) and the palmar radiocapitate ligament (RCP) appear to consist of a material of a relatively high tangent modulus, about 93 and 83 MPa, respectively. The other seven ligaments tested have similar tangent moduli, ranging from 25 to about 50 MPa.     

Biomechanical properties of human lumbar spine ligaments.

Biomechanical properties of the six major lumbar spine ligaments were determined from 38 fresh human cadaveric subjects for direct incorporation into mathematical and finite element models. Anterior and posterior longitudinal ligaments, joint capsules, ligamentum flavum, interspinous, and supraspinous ligaments were evaluated. Using the results from in situ isolation tests, individual force-deflection responses from 132 samples were transformed with a normalization procedure into mean force-deflection properties to describe the nonlinear characteristics. Ligament responses based on the mechanical characteristics as well as anatomical considerations, were grouped into T12-L2, L2-L4, and L4-S1 levels maintaining individuality and nonlinearity. A total of 18 data curves are presented. Geometrical measurements of original length and cross-sectional area for these six major ligaments were determined using cryomicrotomy techniques. Derived parameters including failure stress and strain were computed using the strength and geometry information. These properties for the lumbar spinal ligaments which are based on identical definitions used in mechanical testing and geometrical assay will permit more realistic and consistent inputs for analytical models.     

Cutaneous ligaments of the human hand

A topographical study concerning the cutaneous ligaments of adult as well as human fetal hands was performed. In order to be able to preserve the cutaneous ligaments in their entirety two different methods, a careful dissection and a new histological technique, have been employed. The results of these methods are compared and the detailed topography of the different cutaneous ligaments is clarified. In addition to topographical details, the functional co-operation of the ligaments especially in regard to their clinical relevance is reported.     

The retaining ligaments of the cheek

The zygomatic ligaments (McGregor's patch) anchor the skin of the cheek to the inferior border of the zygoma just posterior to the origin of the zygomaticus minor muscle. The mandibular ligaments tether the overlying skin to the anterior mandible. Both these ligaments are obstacles to surgical maneuvers intended to advance the overlying skin. They also restrain the facial skin against gravitational changes, and they delineate the anterior border of the "jowl" area. The platysma-auricular ligament is a thin fascial sheet that extends from the posterosuperior border of the platysma and that is intimately attached to the periauricular skin; it serves as a surgical guide to the posterosuperior border of the platysma. The anterior platysma-cutaneous ligaments are variable fascial condensations that anchor the SMAS and platysma to the dermis. They can cause anatomic disorientation with dissection of false planes into the dermis. These four ligaments are useful as anatomic landmarks during facial dissections. The tethering effects of the zygomatic and mandibular ligaments must be interrupted if a maximum upward movement of the facial skin is desired.