[The importance of the metacarpal bone index in the evaluation of uremic osteopathy]

71 patients with chronic renal failure were analysed. The patients were treated (N1 = 32) and not treated (N2 = 39) with chronic intermittent hemodialysis. In all analysed patients and in the control group of 20 patients sex and age matched to the examined groups) the outside (D) the inner diameter of the middle II metacarpal bone of the dominant hand was measured (a precision of 0.1 mm was reached using Yashio, Japan, magnifying glass) and the following "metacarpal" indexes were calculated: 1. Garn's Index:--thickness in the cortical bone in mm (D-d) 2. Nordin's score:--percentage of the cortical bone [formula: see text] 3. Garw's area:--cortical bone surface [formula see text] 4. The quantity of the corical bone thickness and the bone surface [formula: see text] From the results received by the analysis it could be noted that the tested patients with chronic renal failure, regardless of chronic intermittent chronic dialyses, showed a negative interdependence on the relation: "PTH-metacarpal index", that indicates the conclusion that the bone destruction is greater if the levels of plasma C-iPTH are higher. The similar can be noticed with the comparison of the C-iPTH-value of the periostitic lacunas in the cortex of the iliac bone (r = 0.64, i.e. higher concentration of C-iPTH agrees with larger surface of lacunar periostitis). Finally, the thickness of the outer cortex of the iliac bone is smaller if the values of C-iPTH are higher (r = 0.12, patients treated with hemodialysis).

Transphyseal vessel involvement in repair of metaphyseal retained cartilage

A foal with retained cartilage in the distal metaphysis of the right and left radii and third metacarpal bones had abnormal physeal vasculature. In areas where cartilage was retained, vessels crossed the physis, and branched at the physeal-metaphyseal junction or at the site of retained cartilage. Vessels appeared to be involved in re-initiation of endochondral ossification and in the repair reponse to the presence of retained cartilage. In areas where the physis was radiographically and histologically normal, no vessels crossed the physis. A function of transphyseal vessels may be as a reserve blood supply in areas of metaphyseal abnormality, at a stage of maturity when metaphyseal vessels are not well developed.

Tendonitis of the deep digital flexor tendon in the distal metacarpal/metatarsal region associated with tenosynovitis of the digital sheath in the horse

Twenty-four horses with ultrasonographic evidence of tendonitis of the deep digital flexor tendon in the metacarpal/metatarsal region were seen over a 7 year period. Most horses had mild to moderate lameness and distension of the digital flexor tendon sheath in the affected limb. Intrasynovial analgesia of the digital flexor tendon sheath consistently improved the degree of lameness. Ultrasonography most commonly revealed small, distinct, often circular, focal hypoechoic areas within the deep digital flexor tendon which usually extended less than 1 cm proximodistally. The degree of lameness and swelling generally improved with box rest and controlled exercise, however, exacerbation of the clinical signs and ultrasonographic lesions was common when affected horses were returned to work or allowed free exercise at pasture. Of 24 cases, only 7 horses made a full recovery and returned to their intended athletic activity.

Rothmund-Thomson syndrome in fraternal twins

Fraternal twins of Malay descent had the Rothmund-Thomson syndrome. This is a rare, autosomal recessive disorder characterized by photosensitivity, poikiloderma, short stature, skeletal defects, and juvenile cataracts. This is the first case report of the syndrome from southeast Asia.

[Diaphyseal sequestration of the hollow bones in cattle]

Between 1990 and 1993 ten cows with diaphyseal sequestration of the metacarpal or metatarsal bone were brought to the Clinic for Food Animals and Horses, University of Bern. History, clinical and radiographic findings at admission, therapy, and clinical and radiographic short- and longterm results were evaluated retrospectively. Six animals had a history of trauma. The metatarsal bone (n = 9) was much more frequently affected than the metacarpal bone (n = 1). Lameness was slight in seven cases and intermediate in three cases. Soft tissue swelling was present in all cases, and fistula formation in eight cases. Sequestrectomy was performed in nine cases, the exuberant new bone circumferentially removed in three of these cases, and the skin primarily closed in all nine cases treated surgically. One animal with a small sequestrum, showing no fistula formation, was treated conservatively. Four to 44 months after surgery, interviews with the owners by telephone revealed that the recovery had been satisfactory in all ten cases. At the same time period, clinical and radiographic examinations of the six animals that were still alive were performed by a veterinarian additionally. Normal limb function had been restored in all six animals, although the affected limb was clearly distinctable from the unaffected contralateral limb, because of its increased diameter. From the results of this study we concluded that longterm prognosis after sequestrectomy is favourable; primary wound closure can be attempted with good success. Cosmetically promising results, however, can only be achieved, if sequestrectomy is performed early enough in the course of the disease or if the exuberant new bone is surgically removed.

[Postmortem reconstruction of metabolic rates using histomorphometry of buried human compact bones]

Histomorphometry of archaeological human bone permits the invivo-reconstruction of bone physiology as well as a quantification of the typical age changes in compact bone. Compact bone samples from 31 well preserved metatarsalia and one metacarpus of excavated adult male skeletons from early-mediaval site of Altenerding (administrative district Erding, Upper Bavaria), were cut into thin sections, whose microstructural components were measured histomorphometrically with a semiautomated image-analyser. The thus obtained raw data were used for the calculation of the remodeling rate during lifetime as well as for histomorphometrical age determination. Results of the histomorphometrical age determination were then compared with existing macromorphological data and those obtained from the incremental lines of the dental cementum. This comparison revealed obvious method-specific differences: macromorphological data tend to be too low, while the histomorphometrically determined ages of death are estimated as being too high. The calculation of remodeling rates in haversian bone required a combination of three different algorithms. Herewith, a continuous decrease in average values of 1.06/mm2/a for the average annual osteon formation rate mu and 0.035 mm2/mm2/a for the average annual haversian bone formation rate appeared in the sample. Further age-dependent variability and species-specific characteristic structural features of the cortex were investigated. Osteons tend to become smaller with increasing individual age as expected, but no increase of the haversian canals was found. Comparative values taken from histological and anatomical literature are constantly agreeing with the measured data of the microstructural components. In the case of a both osteoporotic and osteomyelitic bone, histomorphometry proved to be a valuable method for palaeopathological diagnosis.

Finite element analysis of pathogenesis of osteoarthritis in the first carpometacarpal joint

Stress distribution in the first carpometacarpal joint was analyzed in 49 cadaveric hands using the finite element method to clarify the pathogenesis of osteoarthritis in the joint. The results of the finite element method analysis were compared with those of the contact pressure distribution in the first carpometacarpal joint of cadaveric specimens using pressure-sensitive film, and with the simple roentgenographical and microradiographical manifestations of spur formation, and with histological findings of osteoarthritis to verify the accuracy of the models of computer simulation models. The comparison of these results showed that osteoarthritic changes of the first carpometacarpal joint were found in areas where stress was concentrated during movement of the joint. The saddle shape of this joint is essentially well-designed for the dispersion of normal stress, however minimal displacement due to instability could easily induce osteoarthritis. Furthermore the shallow trapezial configuration may contribute to the high incidence of osteoarthritis changes. The finite element method helped clarify the relationship between stress patterns and osteoarthritis response.

Comparison between metacarpal bone measurements by computarized radiogrammetry and total body DEXA in normal and osteoporotic women

We evaluated the precision of metacarpal radiogrammetry by computed radiography as a technique for bone mass measurement. Measurements obtained using this method were compared with densitometric measurements of total body bone mass using dual-energy X-ray absorptiometry. Our results showed that the coefficients of variation for radiogrammetric measurements were similar in 60 women with osteoporosis and in 100 normal women: 0.7% in both groups for external diameter of the second metacarpal, 2.41% in the normal women and 2.03% in the women with osteoporosis for internal diameter, and 2.3% and 2.4%, respectively, for cortical thickness. Except for external metacarpal diameter, which did not differ between normal and osteoporotic women, all the measurements were smaller in the women with osteoporosis (p < 0.001). The correlation between metacarpal cortical thickness and total body bone mineral content was r2 = 0.462 in the women with osteoporosis, r2 = 0.476 in the controls, and r2 = 0.522 in the two groups combined (all p < 0.001). There was a significant correlation (p < 0.001) between cortical thickness and densitometric metacarpal measurements of both the diaphysis and epiphysis. These results confirm the value of radiogrammetry as a technique for quantitating bone mass under normal and pathological conditions. Additional advantages of the method are minimal radiation dose delivered, possibility for storing the image and data, and technical facility.

Metacarpal bone mass in normal and osteoporotic Japanese women using computed X-ray densitometry

The metacarpal bone mineral density (BMD) and metacarpal index (MCI) of the second metacarpal bone were measured by computed X-ray densitometry (CXD) (Teijin Ltd., Tokyo), which we have established with the development of microdensitometry of radiographs. In this study, we evaluated the basic attributes of this CXD method and determined the age-related changes in both metacarpal measurements in normal Japanese women. The precision in vivo was measured in eight subjects. The precision errors [coefficient of variation (CV)] were 0.2-1.2% CV for metacarpal BMD and 0.4-2.0% CV for MCI, respectively. We have obtained low precision error and more rapid analysis, within 3 minutes respectively, compared with the previous methods. Age-related changes in the metacarpal measurements were evaluated in 1438 normal women. Both measurements showed the most significant decrease in the sixth decade of life. The rate of decrease in the sixth decade was 1.6%/year for metacarpal BMD and 1.5%/year for MCI. On comparison between metacarpal BMD by CXD and spine BMD using dual energy X-ray absorptiometry (DXA) in 248 normal women with and without menstruation, the two measurements were found to be similarly decreased in the subjects within 5 years after menopause. There was also no significant difference in the Z-score between metacarpal BMD and spine BMD within 5 years after menopause. These results indicate that early postmenopausal bone loss occurs not only in the spine but also in the metacarpal bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms of cortical bone loss from the metacarpal following digital amputation

Immobilization bone loss, whether due to whole body immobilization or local causes, is associated with an initial rapid phase of trabecular bone loss, but the long-term effects of immobilization on cortical bone are not well described. We have studied metacarpal morphometry in 16 men who had undergone partial or complete traumatic digital amputations 4-71 years earlier. Noninvolved metacarpals from the affected and unaffected hands were used as controls. Cortical bone width was significantly reduced in the metacarpals proximal to the amputated digits (P = 0.001). In the 7 subjects who suffered amputation before the age of 19, the cortical bone deficit was primarily due to a reduction in the total width of the medullary shaft (P = 0.007), whereas medullary width was not changed. In these subjects the metacarpal was also significantly reduced in length, by a mean 2.9 mm (P = 0.35). In the 9 subjects who had their amputation after the age of 19, both a reduction in total width and an increase in medullary width (P = 0.017) accounted for the cortical bone deficit. The deficit in total width was related to the time since amputation (P = 0.008) and could be accounted for by loss of the normal age-related increase in total width (0.01 mm/year). We conclude that in this model of immobilization osteoporosis, the metacarpal proximal to the amputated digit demonstrates cortical osteopenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Appendicular bone mass and osteoarthritis of the hands in women: data from the Baltimore Longitudinal Study of Aging

OBJECTIVE

The association of appendicular bone mass with hand osteoarthritis (OA) was studied in 238 Caucasian female participants aged 40 and above in the Baltimore Longitudinal Study of Aging.

METHODS

Bilateral hand radiographs taken between 1978 and 1991 were read for grade of OA using Kellgren-Lawrence scales. Two measures of appendicular bone mass, percent cortical area of the second metacarpal and bone mineral density of the distal radius measured with single photon absorptiometry, were assessed at the same visit.

RESULTS

Bivariate analyses showed that increasing grade of hand OA was associated with increasing age and decreasing bone mass as measured by both techniques. After adjustment for age and body mass index, however, neither of these measures of appendicular bone mass remained significantly associated with grade of hand OA.

CONCLUSION

Our data fail to support the hypothesis that increased appendicular bone mass is associated with hand OA in women.

Metacarpophalangeal pattern profile analysis in Sotos and Marfan syndrome

Patients with Sotos and Marfan syndrome have unusually long metacarpals and phalanges which may make the differential diagnosis difficult in younger children. Using Q-scores, we compared metacarpophalangeal pattern profile (MCPP) analysis in these two syndromes and identified distinct and different pattern profiles. This illustrates that the MCPPs are specific in these syndromes, even at an early age, and not related solely to the unusually long metacarpals and phalanges. For this study we used data from 50 Sotos patients (34 from the United Kingdom and 16 from the Netherlands, with a total of 95 hand films) and 36 Marfan patients (from the Netherlands, with 98 hand films). Of all patients over age 3 years the bone length (including the epiphysis) was determined. The patients under 7 1/2 years (29 Sotos and 12 Marfan) were also measured without inclusion of the epiphysis. The patients measured without epiphysis had a relative short metacarpal 1 (MC1) and long distal phalanx 1 (DPh1) in Sotos syndrome, and a relative long MC1 and short DPh1 in Marfan syndrome. Between age 3 and 7 1/2 years more than 90% of the films could be classified correctly using these two variables. Of the roentgenograms measured with epiphyses, about 80% were classified correctly.

[Aneurysmatic bone cyst of the 2nd metacarpal bone. A case report]

The aneurysmatic bone cyst of the hand is a rare clinical entity. On the basis of a 13-year-old girl with affection of the second metacarpal, the problem is explained and the various possible therapies are discussed. After ample resection, we decided in our case to transplant a vascularized bone graft from the iliac crest. Until today, this procedure has not been described in the literature.

[Cartilage degeneration and measurement of the contact area of the trapeziometacarpal joint: morphological observation]

To clarify the pathogenesis of osteoarthritis in the trapeziometacarpal (TM) joint, the correlation of the location of osteoarthritic changes with the contact area of the joint was investigated in 102 TM joints from 51 anatomical cadavers. The location of the osteoarthritic changes was studied macroscopically and its severity was classified according to the modified North's classification. The location and area of the articular contact were determined by using the casting method in various positions of the thumb, and the ratio of the contact area to the total joint area was also calculated. Degenerative change was observed frequently in the radial, volar and ulnar segments of the trapezium and in the ulnar segment of the metacarpal bone. When the thumb was held in opposition, the contact area of the trapezium was located in the radial, volar and ulnar segments, corresponding to the place where degeneration of the cartilage frequently occurred. The contact area was the largest with the thumb in opposition. These findings suggested that the TM joint was most stable in opposition where transmission of compressive force was higher than in the other positions. This study revealed that trapeziometacarpal arthritis may be the result of compression forces across the joint with the thumb in opposition.

Necrosis of the first metacarpal bone in a case of acute lymphatic leukemia in childhood

A 4-year-old girl suffering from acute lymphatic leukemia (ALL) was treated with cortisone and chemotherapy. During treatment a blister developed on the dorsum of her right hand, followed by a subsequent necrosis of the underlying tissue and of the first metacarpal bone. Recurrent suppression of bone marrow prevented an immediate single step reconstruction with a microvascular metatarsal bone transfer. Instead, the soft tissue defect was first covered with a pedicled groin flap and the skeleton of the thumb was supported with an external fixator. Then, a free fibular bone graft was transferred. During a complete remission of ALL, a microvascular transfer of the metatarsal bone and joint was finally performed. Two years after reconstruction the right hand is still the dominant one and both thumbs grow proportionately.

[Rapidly growing tumor of the hand--is tuberculosis as differential diagnosis gaining increased importance?]

A two-year-old healthy, Portuguese girl presented with a prominent, painless tumor over the first web space of the left hand. The tumor increased rapidly in size over a few weeks, but caused no functional problems. On X-ray films, a cystic structure of the first metacarpal bone with erosion of the corticalis was demonstrated. At operation, a "cold abscess" was found. Bacterial examination of the gastric juice showed acid-resistant bacilli. The spina ventosa (Latin: Spina-"a thorn"; ventosa-"full of wind, distended") is a typical extrapulmonary manifestation of tuberculosis in phalangeal, metacarpal, and metatarsal bones of children. The recognition of this diagnosis is very important and will become more so in the future as it has already been seen in HIV-positive children in the USA, as well as in immuno-suppressed children and in un-vaccinated and malnourished children from war zones in eastern Europe.

Osteoblastic osteogenic sarcoma in a 13-month-old girl

Osteosarcoma is exceptional in early periods of life. Therefore osteosarcomas involving the bones of the hand are extremely rare. We present a case of an osteogenic sarcoma involving the second metacarpal bone of a 13-month-old girl who has been remaining free of disease, after treatment--radial amputation and chemotherapy pre- and postoperative--, for a period of 10 years in the follow-up.

Metacarpal index in Marfan's syndrome and in constitutional tall stature

The metacarpal index (MCI) in 54 children with constitutional tall stature was mean (SD) 8.65 (0.8) and in 55 with Marfan's syndrome 9.15 (0.9). Indices in both groups showed arachnodactyly and differed from those found in normal individuals (< 7.9). Because the MCI is a poor discriminator patients with tall stature or clinical signs of arachnodactyly should be examined for additional signs of Marfan's syndrome or other hereditary disorders of connective tissue.

Primary bone lymphoma: report of an unusual case with a review of the literature

Primary bone lymphoma is uncommon and usually involves the long bones. We report a patient with involvement of a metacarpal bone, and review the literature.

Nonepiphyseal ossification and pseudoepiphysis formation

Direct ossification extending from the metaphysis into the epiphysis preceded and continued to be more mature than formation and expansion of the typical epiphyseal ossification center at the opposite end of each longitudinal bone of the hand and foot. Direct metaphyseal to epiphyseal ossification usually started centrally and expanded hemispherically, replacing both physeal and epiphyseal cartilage simultaneously. When remnants of the "physis" were retained, however, while juxtaposed epiphyseal cartilage was replaced, a pseudoepiphysis formed. Three basic patterns of pseudoepiphysis formation were evident: (a) a central osseous bridge, (b) a peripheral osseous bridge, and (c) multiple bridging. In each condition, the remnant of the "physis" lacked typical cell columns capable of contributing to the postnatal longitudinal growth of the involved bone. Pseudoepiphyses were well formed by 4-5 years and coalesced with the rest of the bone months to years before skeletal maturation was attained at the opposite epiphyseal end.

Case report 806: Monostotic Paget's disease of the hand (fifth metacarpal)

Monostotic Paget's disease of bone is an uncommon disease, reported in the hand in only a few instances. We have described an additional case involving a metacarpal bone in a 43-year-old man. We believe this disease should be considered in the radiological differential diagnosis of lytic expansile, subchondral lesions of the hand.

Monostotic fibrous dysplasia in the hand. A case report

We present in this paper a new case of monostotic fibrous dysplasia in the hand. The reason for this communication is the rarity of this osseous dystrophy in the hand as well as its radiologic features as a malignant osseous tumor, being a lytic lesion with incomplete periostic reaction.