Diagnosis of the aetiology of a locked metacarpophalangeal joint using MRI

A case is reported of a locked MP joint due to ulceration of the metacarpal head. This was clearly visible on MRI scan.

Extensor tendon lacerations in horses: 50 cases (1982-1988)

Medical records of 50 horses with extensor tendon lacerations affecting 53 limbs over 7 years (1982 to 1988) were reviewed to determine the clinical features and prognosis for athletic soundness after treatment. Mean and median ages were 4.8 and 3 years, respectively. Eighty-nine percent of the injuries involved the hind limbs, with approximately equal distribution between the right and left limbs. Hind limb lacerations involved the long digital extensor tendon (28 limbs), lateral digital extensor tendon (3 limbs), or both tendons (16 limbs). Forelimb lacerations involved the common digital extensor tendon (2 limbs), lateral digital extensor tendon (1 limb), or both tendons (3 limbs). Joint involvement was found in 6 cases. Wound management varied according to wound characteristics, financial constraints of owners, and clinician preference. External coaptation consisted of a 3-layered cotton bandage in 33 limbs, splint and cotton bandage in 12 limbs, fiberglass or plaster-of-Paris cast in 5 limbs, and no form of coaptation in 3 limbs. Follow-up information for 40 cases at least 1 year after injury revealed that 29 (73%) horses had returned to athletic soundness, 7 (18%) horses were pasture sound, 3 horses were chronically lame, and 1 horse was euthanatized during treatment because of wound sepsis. Depending on the hind limb tendons involved, return to athletic soundness ranged from 62% (long digital and lateral digital extensor tendons lacerated) to 80% (long digital extensor tendon lacerated) The small number of forelimb lacerations precluded any comparative data.(ABSTRACT TRUNCATED AT 250 WORDS)

Sex determination from metacarpals and the first proximal phalanx

Sex determination using metacarpals and the first proximal phalanx was carried out on a sample (n = 60) of documented sex. Six measurements were taken on each of metacarpals 1 to 5 and the first proximal phalanx. Regression equations were calculated for determining sex from the bones. The equations were then applied to a second sample (n = 20) also of documented sex to establish the degree of accuracy they produced in assigning sex. The equations for metacarpal 1 produced the highest degree of correct sex determination and overall the degree of accuracy ranged from 74% to 94%.

Idiopathic multicentric osteolysis: family report and review of the literature

A mother and son affected by idiopathic multicentric osteolysis are reported. This condition usually manifests in early childhood and is characterized by progressive destruction of the carpal and tarsal bones, with or without renal anomalies. Unusual facies might be the clinical features of the syndrome. Review of the literature shows that osteolysis can occur in isolation or may be associated with renal and/or facial anomalies.

Heritability estimations of osteochondrosis in the tibiotarsal joint and of bony fragments in the palmar/plantar portion of the metacarpo- and metatarsophalangeal joints of horses

Radiography of the tibiotarsal and metacarpo- and metatarsophalangeal joints was performed on 753 Standardbred trotters (6 to 21 months old) born in 1988. The surveyed population was drawn at random from all parts of Norway and represented about 60% of Standardbred trotters born the same year. Osteochondrosis in the tibiotarsal joint was diagnosed in 108 (14.3%) horses, and the prevalence of disease in progeny groups > 10 ranged from 0 to 69%. Bony fragments in the palmar/plantar portion of the metacarpo- and metatarsophalangeal joints were diagnosed in 89 (11.8%) horses, and the prevalence of disease in progeny groups > 10 ranged from 0 to 41%. Heritability analysis was restricted to 644 horses, comprising groups of 5 or more progeny, from 39 stallions. The heritabilities of osteochondrosis in the tibiotarsal joint and of bony fragments in the palmar/plantar portion of the metacarpo- and metatarsophalangeal joints were estimated to be 0.52 and 0.21, respectively, using a nonlinear model.

Relationships between metacarpal morphometry, forearm and vertebral bone density and fractures in post-menopausal women

The relationships between metacarpal morphometric, vertebral and forearm density measurements and the prevalence of vertebral and peripheral fractures were examined in 239 postmenopausal women (median age 63, range 32-84 years). Metacarpal cortical area/total area ratio (CA/TA) was measured with needle calipers, forearm mineral density (FMD) by single photon absorptiometry and vertebral mineral density (VMD) by single energy quantitative computed tomography. Of the 239 subjects 97 had not suffered any fractures, 44 had at least one previous vertebral fracture but no peripheral fractures, 41 had a history of peripheral fracture but no vertebral fracture and 57 had suffered both peripheral and vertebral fractures. There were significant correlations between a single measurement of CA/TA and both FMD (r = 0.65, p < 0.001) and VMD (r = 0.41, p < 0.001). Similar correlations existed between the mean of multiple measurements of CA/TA and both FMD and VMD. CA/TA (p < 0.001), FMD (p < 0.001) and VMD (p < 0.001) were reduced in subjects who had suffered fractures, when compared with the no fracture group. The percentage of cases in each of the four fracture groups (vertebral fracture only, peripheral fracture only, peripheral and vertebral fracture, peripheral or vertebral fracture) misclassified with reference to the no fracture group were similar with CA/TA, FMD or VMD measurements. We suggest that metacarpal morphometry, which is widely available at relatively low cost, yields cross-sectional information about bone density and fracture risk, comparable with that obtained by forearm and vertebral densitometry.

Low-velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone grafting

The results of early stable fixation of 64 metacarpal fractures due to low-velocity gunshot wounds in 49 patients were reviewed retrospectively. These reconstructive procedures were performed between 1 and 7 days after injury and involved stable internal fixation supplemented with primary iliac crest bone graft in 40 fractures with bone loss or comminution. Postoperatively, the hands were splinted with 90 degrees of metacorpophalangeal flexion while early interphalangeal motion was emphasized. Follow-up averaged 12 months, with a range of 4 months to 7 years. Primary bone union was achieved in all metacarpals. The average range of motion was 65 degrees for the metacarpophalangeal joint, 72 degrees for the proximal interphalangeal joint, and 60 degrees for the distal interphalangeal joint. Complications included two superficial infections. There were no cases of deep infections or persistent draining wounds. Early, stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.

Ulnar translation of the carpus in rheumatoid arthritis: an analysis of five determination methods

Five x-ray methods of assessing ulnar translation of the carpus were compared to each other. Overall, we found the uncompensated semiquantitative method proposed by Gilula et al. to be the most practical and the best method with a sensitivity index of 82%, a specificity index of 88%, an accuracy of 87%, and an interobserver correlation of 90%. The method, however, decreased in specificity and accuracy when a corrective formula was applied to adjust the ulnometacarpal angle to zero degrees deviation. Our conclusion is that the sensitivity indices are relatively low for all methods, and underdiagnosis may occur. At present the semiquantitated method of Gilula et al. is the most practical, with the highest sensitivity index, and is recommended as a screening tool for assessment of ulnar translation of the carpus.

[New radiologic data on the trapezo-metacarpal joint. The results of 330 cases]

Systematic x-rays in specific views and maximal amplitude of 330 trapezo-metacarpal joints in patients presenting with hand lesions has enabled us to define some original radiological parameters: the angle of the trapezium, the slope angle of the trapezium in anteversion and retroversion, trapezium mobility, the subluxation coefficient and the contact arc of the first metacarpal (M1) on the trapezium, defective reintegration of the base of the first metacarpal into the curve of the trapezium on AP and lateral views and the length of the intermetacarpal ligament. Statistical analysis, using analysis of variance, Chi-square test and correlation tests have demonstrated some correlations between all of these parameters allowing us to propose a pathophysiological hypothesis. In particular, this study emphasised the important role of a failure of the intermetacarpal ligament in the pathogenesis of proximal osteoarthritis of the thumb. Long before the onset of the well known signs of osteoarthritis, narrowing of the joint line and osteophytes, precursor radiological signs can be detected: loosening of the intermetacarpal ligament, excessive mobility of the trapezium, and poor reintegration of the base of M1 in the trapezium curve on AP and lateral films should now allow the early diagnosis and the proposal of preventive operations, such as intermetacarpal ligamentoplasty, reorientation osteotomies of the trapezium facet when the trapezium angle is too wide or new surgical techniques on the abductor carpi radialis, an almost constant expansion of the abductor pollicis longus on the trapezium.

[The destabilization of the 1st carpo-metacarpal joint in musicians' cramp]

Destabilisation of the first carpometacarpal joint in musicians and in occupational cramps constitutes a functional dystonia. Joint laxity predisposes to these conditions as well as the musician's technique or the working position. This destabilisation can cause a lesion of the anterior oblique ligament of the trapezo-metacarpal joint progressing towards osteoarthritis in the long term. Rehabilitation attempts to act on the functional dystonia and on the hand by maintaining carpo-metacarpal structures and reinforcing the musculature of the hand.

[Dieterich's disease or Kohler III disease or aseptic necrosis of the metacarpal head]

This article presents a rare disease, aseptic necrosis of the metacarpal head. The study of the literature on the subject and the author's cases reveal that there is no certain etiology. Some cases have a history of trauma but others are spontaneous. A therapeutic attitude is suggested, although not forgetting the rarity of the disease.

Some skeletal dimensions of males with isolated gonadotrophin deficiency

This is a retrospective study of stature and bone age before and during androgen substitution for hypogonadotrophic hypogonadism in 25 males. Before androgen treatment, stature tends to be low for chronological age but normal for bone age. Treatment results in normal final height. Growth in length of metacarpal bone II (MC II), measured on hand radiographs, mimics growth in height. From measurements of total bone width of MC II and combined cortical thickness of MC II, the cortical area (indicating bone mass) and the relative cortical area (indicating bone density) were calculated. Bone mass was well within the limits of a published control series, both before and during androgen treatment. Bone density, however, was, without exception, below the P50 for controls prior to androgen treatment, and increased only slightly during treatment. It is concluded that prepuberal deficiency of androgen, possibly in early infancy, causes a permanent defect in bone density which is only marginally corrected by later androgen treatment.

The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age

It has been suggested that periodontitis and systemic bone mass might be related. In order to evaluate this possible relationship, we performed an intra-oral examination and measured lumbar bone mineral density (lumbar BMD) and metacarpal cortical thickness (MCT) in 286 female volunteers between 46 and 55 years of age. In addition, the alveolar bone height was measured on bite wing radiographs of the dentate subjects. Of the subject, n = 60 (21%) were edentulous. Compared to the dentate subjects, the lumbar BMD and MCT of the edentulous women were not significantly different. In the dentate subjects, no significant correlation was observed between the clinical parameters of periodontitis (mean probing depth, occurrence of bleeding after probing and number of missing teeth) and the bone mass parameters (lumbar BMD and MCT); nor was a significant relation observed between the bone mass measurements and alveolar bone height. We therefore suggest that systemic bone mass is not an important factor in the pathogenesis of periodontitis.

Giant cell tumor in skeletally immature patients

The radiographs and clinical and surgical histories of 50 skeletally immature patients with histologically verified giant cell tumor (GCT) of the long and short tubular bones were retrospectively studied to determine the prevalence, location within bone (eg, epiphysis, metaphysis), skeletal distribution, radiographic appearance, and pathogenesis of GCTs. Skeletal immaturity was determined radiographically by the presence of open epiphyses. Patients were selected from a group of 876 patients who were seen in consultation with documented GCT of the tubular bones. Approximately 5.7% of all GCTs occurred in the skeletally immature (this rate must be viewed with caution due to the selection bias inherent in any referral population). The lesions almost invariably involved the metaphysis. The tibia was the most commonly affected site, representing approximately 26% of cases. All were geographic lytic lesions, with margins ranging from sclerotic to ill defined. An expanded (widened), remodeled bone contour was frequently encountered. Approximately 56% of lesions were solid or solid with cystic change; the remaining 44% were predominantly cystic.

Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint

An anatomic and radiographic study of the osteoarthritic trapeziometacarpal joint was conducted on 27 surgical specimens harvested during basal joint arthroplasty. Surface wear patterns were analyzed by hyaline cartilage staining, and relative involvement of trapezium and metacarpal was calculated as the trapezium/metacarpal eburnation ratio. Eburnation occurred only on facing trapeziometacarpal surfaces in contact areas of the palmar compartment. Metacarpal degeneration began at the palmar joint margin adjacent to the beak ligament and extended dorsally, while trapezial degeneration originated on the central palmar slope and spread centrifugally with more advanced disease. Eburnation consistently involved a greater surface area on the trapezium than on the metacarpal in a ratio of nearly 3:1. A decreasing trapezium/metacarpal eburnation ratio correlated closely with worsening radiographic stage. These observations suggest translation of metacarpal on trapezium in the production of arthritic surface lesions and support a hypothesis of pathologic joint instability as the cause of trapeziometacarpal osteoarthritis.

Forearm deformities in multiple cartilaginous exostoses

Sixteen patients with 20 forearm deformities were reviewed. The deformities were classified into three types. The degree of ulnar tilt of the radius, ulnar displacement of the carpus, and relative ulnar shortening were determined. The severity of the deformity correlated with these measurements. Metacarpal lengths were also measured. Significant metacarpal shortening without exostoses was seen in 10 of 11 patients and with exostoses remote from the metaphysis in 10 of 13 patients. Metacarpal shortening correlated with the type and severity of deformity.

The measurement of osteoporosis in clinical practice

It has been reported that metacarpal morphometry does not correlate with iliac crest histomorphometry in patients with hip fractures. Such disagreement led us to study the correlation between both types of measurements on 35 patients who had suffered hip fracture. We observed a significant correlation between metacarpal morphometry and iliac crest cortical width (p less than 0.001), and to a lesser degree with the trabecular bone volume (p less than 0.01). The same was also true if we assessed separately the patients with cervical or trochanteric hip fractures.

Spondyloarthropathy: erosive arthritis in representative defleshed bones

Erosive changes and syndesmophyte formation, characteristics of spondyloarthropathy, were present in 79/2906 skeletons in the Todd Collection. Holistic assessment of this defined population allowed it to be distinguished from rheumatoid and other erosive forms of arthritis. Characterization of the nature and distribution of osseous alterations in a contemporary skeletal population allowed development of a standard for recognition of the disease in skeletal populations.

Long-term evaluation of Silastic trapezial arthroplasty in patients with osteoarthritis

This study of 151 Silastic trapezial arthroplasties evaluates the long-term radiographic and clinical results in patients with osteoarthritis. A radiographic grading system was developed to objectively evaluate and quantify changes seen at the implant-bone contact areas, within the metacarpal medullary canal and distal pole of the scaphoid. Trapezial arthroplasties studied on average of 51 months after implantation revealed that in 56% (85 of 151) of scaphoids cysts had developed, and 74% (111 of 151) of the metacarpals had intramedullary radiolucency and/or cysts. Histopathologic evaluation of the areas of radiographic changes demonstrated silicone synovitis. Statistical analysis revealed that the radiographic changes in the scaphoid and medullary canal of the metacarpal were not directly related to time. Patient satisfaction, found to be 84% (127 of 151) of the study population, did not correlate with the grade of scaphoid or metacarpal radiographic change. This systematic radiographic grading system has been found useful in the long-term durability evaluation of Silastic trapezial arthroplasties.

Papillon-Lefèvre syndrome with acroosteolysis

The Papillon-Lefèvre syndrome is characterized by palmoplantar hyperkeratosis and juvenile periodontitis that results in the precocious loss of both the deciduous and permanent teeth. We report a patient with Papillon-Lefèvre syndrome associated with acroosteolysis, an association that has not been previously described.

Avascular necrosis and vascular anatomy of the metacarpals

Aseptic necrosis of the metacarpal head is extremely rare and has been described in association with systemic lupus erythematosus, steroid use, trauma, and other sites of bone infarction. The long metacarpal is the most commonly involved. The extrinsic and intrinsic vascular anatomy of the metacarpal is described in fifty metacarpal specimens. No definite conclusions can be drawn about anatomic variations in blood supply between the different metacarpals. However, in 35% of the specimens, a main arteriole in the distal epiphysis was absent, making these metacarpal heads solely dependent on small circumferential pericapsular arterioles. This group of metacarpals, when associated with other risk factors, such as trauma, systemic lupus erythematosus, or steroid use, may be at increased risk for the development of aseptic necrosis.

Increased metacarpal bone mass following 18 months of slow-acting antirheumatic drugs for rheumatoid arthritis

Osteoporosis in RA is mediated by numerous inflammatory substances. This study was undertaken to see if SAARD could modify the rate of metacarpal bone loss in RA. Combined cortical thickness (CCT) measured at the midshaft of the right second metacarpal was used to calculate bone mass (CA%) using a digitizer. Eighty-one subjects were studied, all of whom had at least three sets of hand X-rays, the last of which was approximately 18 months following initiation of SAARD therapy. There were 12 males and 69 females. The mean age at time of starting therapy was 51 (SD 12) years while the mean duration of disease at the time was 7.6 (SD 8) years. The mean time to referral for SAARD from the general clinic was 2.5 (SD 3) years. The percentage fall in bone mass prior to therapy was 2.51%/day compared to a gain of 0.6%/day after therapy (P less than 0.05). Forty-nine patients were aged over 50 years while 32 were 50 years or younger at the time of study. Comparison showed that in the pretreatment period, the rate of change in CCT and CA% was not significantly dependent age (P less than 0.1). During that therapy, the rate of change in CCT and CA% significantly different in the two age groups. Patients aged over 50 years continued to lose bone, but at a slower rate (P less than 0.05). Patients aged 50 years or less either stopped losing or gained metacarpal bone mass during the study period (P less than 0.005). The time to referral for SAARD and disease duration (comparable in the two age groups) did not have a significant effect on changes in CA% during therapy. Change in bone mass could be predicted by change in disease activity. We conclude that SAARD have a significant sparing effect on metacarpal osteoporosis in RA. This positive effect is masked by the overwhelming influence of age (and menopause) and could be missed. Metacarpal osteoporosis seems a pathophysiologically more useful measure of radiological change in RA than erosions or joint space narrowing.

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